Post RN BSN Advance Concepts in Nursing-III – Unit III Schizophrenia, Personality Disorders and Antipsychotics Solved Answers
 |
| Schizophrenia, Borderline Personality, Antipsychotics Solved | Post RN BSN Use as a revision guide and verify with your course notes. |
Unit III: Schizophrenia, Personality Disorders and Antipsychotic Medications
Course syllabus · Model exam answers
B.Sc NURSING (POST-RN), SECOND YEAR, SEMESTER-III
ADVANCE CONCEPTS IN NURSING-III – COURSE NO. 715
UNIT III: SCHIZOPHRENIA, PERSONALITY DISORDERS AND ANTIPSYCHOTIC MEDICATIONS
Syllabus topics: Schizophrenia; altered thought process; personality disorders; borderline personality disorder; passive-aggressive personality disorder; antipsychotic medications.
Q-1. Define schizophrenia. Describe its epidemiology and the course of the illness.
Schizophrenia is a chronic, severe mental disorder with disturbances of thinking, perception, emotion and behaviour, with loss of contact with reality (psychosis) and reduced functioning. The name (Eugen Bleuler, 1908) means “split mind”: the splitting is between thought, emotion and behaviour, not a “split personality”.
- Occurs in about 1 in 100 people over a lifetime; both sexes; onset usually in late teens to early thirties (often earlier in males).
- Insight is often reduced; the person may not believe he or she is ill.
| Phase | Features |
|---|---|
| Prodromal | Gradual change: social withdrawal, odd ideas, poor sleep, falling school or work performance, neglect of hygiene, irritability |
| Acute (active) | Positive symptoms: hallucinations, delusions, disorganized speech and behaviour |
| Residual | Positive symptoms reduce; negative symptoms and reduced function persist; relapses can occur |
Q-2. Describe the aetiology of schizophrenia.
| Factor | Explanation |
|---|---|
| Genetic | Strong role: risk is about 10% with a parent or sibling affected, and higher with an identical twin; no single gene |
| Neurochemical | Excess dopamine activity in some brain pathways (positive symptoms); glutamate and serotonin involvement |
| Neurodevelopmental / structural | Brain changes such as enlarged ventricles and reduced grey matter; birth complications, prenatal infection or malnutrition, winter birth |
| Environmental and psychosocial | Urban upbringing, childhood trauma, migration, social adversity, high expressed emotion in family |
| Substance use | Cannabis and stimulants can trigger psychosis and relapse |
The stress–vulnerability model explains that people with biological vulnerability become ill when stress exceeds their coping capacity. Poor parenting does not cause schizophrenia.
Q-3. Describe the clinical features of schizophrenia (positive, negative and cognitive symptoms). State the diagnostic requirement.
| Group | Examples |
|---|---|
| Positive symptoms (something added) | Hallucinations (e.g. hearing voices), delusions, disorganized speech (loose association, word salad), grossly disorganized or catatonic behaviour |
| Negative symptoms (something lost) | Affective flattening (blunted emotion), alogia (poverty of speech), avolition (lack of drive), anhedonia (no pleasure), asociality (withdrawal) |
| Cognitive symptoms | Poor attention, memory, planning and problem solving |
| Mood symptoms | Depression, anxiety; high risk of suicide |
Bleuler’s fundamental symptoms (the 4 A’s)
- Affect: flat, blunted or inappropriate.
- Associations: loosening of thought associations.
- Ambivalence: conflicting feelings at the same time.
- Autism: withdrawal into inner world.
Diagnosis (DSM-5-TR outline)
Two or more of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behaviour, and negative symptoms for a significant part of one month, at least one being delusions, hallucinations or disorganized speech; signs of disturbance continue for at least six months; with reduced functioning; not due to a drug, a medical illness, or a mood disorder.
Q-4. Describe the types of schizophrenia.
Earlier classifications described subtypes; DSM-5 no longer uses them, but they are still taught and seen in practice.
| Type | Main features |
|---|---|
| Paranoid | Prominent delusions of persecution or grandeur and auditory hallucinations; relatively preserved thinking; suspicious, hostile; later onset and better prognosis |
| Disorganized (hebephrenic) | Early onset; disorganized speech and behaviour, inappropriate affect, silly giggling, poor self-care; poor prognosis |
| Catatonic | Disturbance of movement: stupor, mutism, negativism, posturing, waxy flexibility or excitement |
| Undifferentiated | Meets criteria but not one of the above types |
| Residual | Past episode with continuing negative symptoms but no prominent positive symptoms |
| Simple (ICD-10) | Gradual development of negative symptoms without hallucinations or delusions |
Q-5. What is altered thought process? Describe the disorders of thought form (flow) with examples.
An altered (disturbed) thought process is a disorder in the form, flow or content of thinking. It is seen in schizophrenia, mania, dementia, delirium and other conditions.
| Term | Meaning | Example |
|---|---|---|
| Loosening of associations (derailment) | Ideas shift from one subject to another with no connection | “I went to the market, the sun is hot, my brother’s car is blue.” |
| Word salad | Jumble of words with no meaning | “Table river quickly my blue the.” |
| Neologism | Made-up words with private meaning | “The plackery is coming.” |
| Clang association | Words chosen by sound | “Pat, cat, sat, hat, I am fat.” |
| Flight of ideas | Rapid, continuous shifting between topics with understandable links (mania) | Speech jumps quickly, but each idea is linked |
| Thought blocking | Sudden stop in the flow of speech | Stops mid-sentence and cannot continue |
| Tangentiality | Replies move away from the question and never reach the point | Asked about sleep, talks about the neighbours |
| Circumstantiality | Unnecessary details but finally reaches the point | Long story before answering |
| Perseveration | Repetition of words or ideas | Repeats the same phrase |
| Echolalia | Repeating the words of another person | Nurse: “How are you?” Client: “How are you?” |
| Poverty of speech / thought | Very little speech or content | One-word replies |
Q-6. Define delusion. Describe its types. How does it differ from an overvalued idea?
A delusion is a fixed, false belief that is not shared by the person’s culture, is held with full conviction, and cannot be changed by logical argument or proof.
| Type | Example |
|---|---|
| Persecutory | “The neighbours are poisoning my food.” |
| Reference | “The news presenter is sending messages to me.” |
| Grandiose | “I am a prophet with special powers.” |
| Somatic | “My organs are rotting.” |
| Jealousy (infidelity) | Fixed belief that the partner is unfaithful |
| Erotomanic | Belief that a famous person is in love with the client |
| Nihilistic | “I am dead; the world has ended.” (severe depression) |
| Control / passivity | Thought insertion, withdrawal or broadcasting; being controlled by an outside force |
An overvalued idea is a strongly held belief that is understandable and not completely fixed. Beliefs accepted by a person’s culture or religion are not delusions.
Q-7. Define hallucination and illusion. Describe the types of hallucination.
A hallucination is a sensory perception without an external stimulus; the person experiences it as real. An illusion is a misinterpretation of a real stimulus (e.g. seeing a rope as a snake).
| Type | Example | Note |
|---|---|---|
| Auditory | Hearing voices commenting, arguing or commanding | Most common in schizophrenia; command hallucinations need risk assessment |
| Visual | Seeing people or animals | More typical in delirium, substance use or brain disease |
| Tactile | Feeling insects crawling on skin (formication) | Cocaine, alcohol withdrawal |
| Olfactory | Smelling burning or rot | Temporal lobe epilepsy, schizophrenia |
| Gustatory | Strange taste | Seen with some psychoses and epilepsy |
| Hypnagogic / hypnopompic | While falling asleep or waking | May be normal |
Q-8. Describe the nursing management of a client with hallucinations and delusions.
| Do | Avoid |
|---|---|
| Build trust with a calm, consistent, honest approach | Arguing with or laughing at the delusion |
| Speak clearly in short, simple sentences | Agreeing with the delusion (“Yes, they are following you.”) |
| Acknowledge the feelings: “It sounds frightening.” | Whispering or laughing in front of the client |
| State your own reality gently: “I do not hear the voices, but I know they are real to you.” | Touching a suspicious client without warning |
| Ask about the voices: what they say, whether they command harm; assess safety | Leaving a client who has command hallucinations alone |
| Distract with reality-based activity: walking, music, simple tasks, talking to staff | Too much stimulation, crowd or noise |
| Orient to time, place and person; use clocks, calendars | Promising what you cannot do |
- Give prescribed antipsychotic medication and monitor response.
- Observe behaviour and record content of hallucinations and delusions in the client’s own words.
- If the client is suspicious of food or medicine, offer sealed packages or let the client see it prepared (as per policy), and check that medicine is swallowed.
- Maintain a safe environment; remove dangerous items; use least restrictive measures; follow policy if the client is agitated.
- Reinforce reality-based talk and activities.
Q-9. Describe the medical and psychosocial management of schizophrenia.
- Antipsychotic medicines: the main treatment; relapse prevention with long-term therapy, including long-acting injections for clients with poor adherence.
- ECT: catatonia, severe agitation or drug-resistant illness (as decided by the psychiatrist).
- Psychosocial treatment: psychoeducation for client and family, cognitive behavioural therapy for psychosis, social skills training, cognitive remediation, supported employment, vocational and occupational rehabilitation.
- Family intervention to reduce expressed emotion and relapse.
- Community care: case management, assertive community treatment, day centres, supported housing.
- Physical health: clients have higher rates of diabetes, heart disease and smoking; monitor and promote healthy lifestyle.
- Treatment of substance use and depression.
Q-10. What are antipsychotic drugs? Classify them and describe their action and uses.
Antipsychotics (neuroleptics, major tranquillizers) reduce psychotic symptoms such as hallucinations, delusions and agitation, mainly by blocking dopamine D2 receptors (second-generation drugs also affect serotonin receptors). They do not cure schizophrenia but control symptoms and prevent relapse.
| Class | Examples | Features |
|---|---|---|
| First-generation (typical) | Chlorpromazine, haloperidol, fluphenazine, trifluoperazine | Effective for positive symptoms; more extrapyramidal side effects (especially high-potency drugs such as haloperidol); chlorpromazine is more sedating with low blood pressure and anticholinergic effects |
| Second-generation (atypical) | Risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, paliperidone | Fewer extrapyramidal effects; some help negative symptoms; more weight gain and metabolic problems (especially olanzapine, quetiapine); prolactin rise with risperidone |
| Clozapine | Clozapine | For treatment-resistant schizophrenia and reduced suicide risk; needs regular blood tests |
| Long-acting injections (depot) | Fluphenazine decanoate, haloperidol decanoate, paliperidone and risperidone long-acting injections | Given every few weeks; improves adherence |
Uses: schizophrenia, acute mania, psychotic depression, delirium agitation, severe behavioural disturbance (short term).
Q-11. Describe the side effects of antipsychotic drugs and their nursing management.
| Side effect | Features | Nursing management |
|---|---|---|
| Acute dystonia | Sudden muscle spasm of neck, jaw, tongue or eyes (oculogyric crisis), within hours to days | Emergency; inform the doctor; anticholinergic (e.g. benztropine) as ordered; reassure the client |
| Akathisia | Inner restlessness; cannot sit still, pacing | May be mistaken for agitation; inform doctor; dose change or drugs as ordered |
| Parkinsonism | Tremor, rigidity, shuffling gait, mask-like face, drooling | Anticholinergic or dose review as ordered; help with mobility |
| Tardive dyskinesia | Late; involuntary movements of tongue, lips, face, limbs | Screen regularly (AIMS scale); report early; may be irreversible |
| Neuroleptic malignant syndrome (NMS) | Rare emergency: high fever, severe muscle rigidity, confusion, unstable blood pressure and pulse, sweating, raised CPK | Stop the antipsychotic; call the doctor at once; cooling, fluids, vital signs, transfer to intensive care |
| Anticholinergic effects | Dry mouth, blurred vision, constipation, urinary retention, tachycardia | Sips of water, sugar-free gum, fibre, fluids, bowel and bladder monitoring |
| Sedation, postural hypotension | Drowsiness, dizziness, falls | Rise slowly; take sedating drug at night; fall precautions |
| Metabolic effects | Weight gain, raised blood sugar and lipids | Weigh regularly; diet and exercise advice; monitor glucose and lipids |
| Hormonal | Raised prolactin: breast milk, missed periods, sexual problems | Report; explain; doctor may change drug |
| Cardiac | QT prolongation; some drugs | ECG as ordered; report palpitations or fainting |
| Others | Photosensitivity (chlorpromazine), jaundice, seizures, agranulocytosis (clozapine) | Sunscreen; clozapine requires white-cell monitoring as per protocol; report fever or sore throat |
General nursing responsibilities
- Give the correct drug at the correct time; check that the client swallows the tablets.
- Teach: do not stop suddenly; avoid alcohol; side effects can be treated, so report them; regular blood tests and follow-up.
- Teach the family to recognize early signs of relapse.
- Monitor blood pressure, pulse, temperature, weight and abnormal movements.
- Document and report side effects promptly.
Q-12. Prepare a nursing care plan for a client with schizophrenia.
| Nursing diagnosis (examples) | Goal | Interventions |
|---|---|---|
| Disturbed thought processes / disturbed sensory perception | Client recognizes that voices are symptoms and uses coping strategies | Therapeutic communication; reality orientation; do not argue; reduce stimuli; medicines; teach coping (humming, listening to music, talking to staff) |
| Risk for violence (self or others) | Remains safe | Assess risk and command hallucinations; early de-escalation: calm voice, space, no threatening posture; remove hazards; follow restraint policy as last resort |
| Social isolation | Participates in group activities | Spend short, regular time with the client; graded group exposure; social skills training |
| Self-care deficit | Performs hygiene and dressing | Daily routine; prompting and praise; assist when necessary |
| Non-adherence | Takes medicine regularly | Teach purpose; side-effect management; long-acting injection; family involvement |
| Compromised family coping | Family understands and supports | Psychoeducation; caregiver support; reduce expressed emotion |
Evaluation: reduced symptoms, safe behaviour, improved self-care and social contact, adherence, and understanding by client and family.
Q-13. Describe the nursing care of a client with negative symptoms and with catatonia.
Negative symptoms
- Do not mistake them for laziness; explain to staff and family that they are part of the illness.
- Establish a daily structure with small, achievable tasks and praise.
- Encourage grooming, meals and activity; gradual social contact; occupational therapy.
- Use a patient, non-demanding approach.
Catatonia
Features: stupor, mutism, posturing, waxy flexibility, negativism, sometimes sudden excitement. Care: maintain nutrition and hydration (observe intake, tube feeding if ordered), turn regularly to prevent pressure sores and contractures, passive exercises and leg care to prevent clots, manage bladder and bowel, speak to the client as if he can hear everything, watch for sudden excitement and for rising temperature. Treatment is by the doctor (benzodiazepine trial, ECT).
Q-14. Describe the prognosis and relapse prevention in schizophrenia.
| Favourable factors | Unfavourable factors |
|---|---|
| Late onset, acute onset, clear stressor, female, good premorbid function, mood symptoms, family support, early treatment, adherence | Early onset, insidious onset, negative symptoms, poor premorbid function, family history, substance use, poor insight, high expressed emotion, delay in treatment |
- Early signs of relapse: poor sleep, withdrawal, suspiciousness, restlessness, stopping medicines.
- Strategies: adherence, regular follow-up, avoid alcohol and drugs, stress management, family education, crisis plan, community support.
- Some people recover well and many live independently with treatment and support. Suicide risk is high, particularly in the early years and after relapse.
Q-15. Define personality and personality disorder. Classify personality disorders.
Personality is the set of enduring patterns of thinking, feeling and behaving that make a person unique. A personality disorder is an enduring, inflexible and pervasive pattern of inner experience and behaviour that deviates markedly from the person’s culture, begins by adolescence or early adulthood, is stable over time and causes distress or impairment. Insight is often poor.
| Cluster | Description | Disorders |
|---|---|---|
| A | Odd, eccentric | Paranoid, schizoid, schizotypal |
| B | Dramatic, emotional, erratic | Antisocial, borderline, histrionic, narcissistic |
| C | Anxious, fearful | Avoidant, dependent, obsessive-compulsive |
Causes
- Genetics and temperament.
- Childhood neglect, abuse, inconsistent or harsh parenting, early loss.
- Brain differences and learning from early relationships; social and cultural factors.
General nursing approach
- Consistent, firm, respectful and non-judgemental attitude; clear, realistic limits.
- Team consistency; regular staff meetings to avoid manipulation and splitting.
- Do not take hostility or flattery personally; manage your own reactions (countertransference) with supervision.
- Teach coping and communication skills; encourage responsibility for behaviour.
- Assess risk of self-harm and violence regularly.
Q-16. Describe the main personality disorders.
| Disorder | Key features |
|---|---|
| Paranoid | Distrust and suspicion; assumes others harm or deceive |
| Schizoid | Detached, prefers solitude, limited emotional expression |
| Schizotypal | Odd beliefs, eccentric behaviour, social anxiety |
| Antisocial | Disregard for rights of others, deceit, aggression, lack of remorse; onset before age 15 with conduct problems |
| Borderline | Unstable relationships, self-image and mood; impulsivity; fear of abandonment |
| Histrionic | Attention-seeking, excessive emotionality, dramatic |
| Narcissistic | Grandiosity, need for admiration, lack of empathy |
| Avoidant | Social inhibition, feels inadequate, fears criticism |
| Dependent | Excessive need to be taken care of; clinging |
| Obsessive-compulsive (OCPD) | Perfectionism, orderliness, control; different from OCD because there are no true obsessions or compulsions and the traits feel “right” to the person |
Q-17. Define borderline personality disorder (BPD). Describe its clinical features, causes and management.
Borderline personality disorder is a Cluster B disorder with a pervasive pattern of instability in relationships, self-image and emotions, and marked impulsivity, beginning by early adulthood. It was named for being on the “border” between neurosis and psychosis; it is now understood as an emotion-regulation disorder.
Clinical features (any five of nine in DSM-5)
- Frantic efforts to avoid real or imagined abandonment.
- Unstable, intense relationships swinging between idealization and devaluation (“splitting”: seeing people as all good or all bad).
- Unstable self-image or sense of self.
- Impulsivity in at least two harmful areas (spending, sex, substance misuse, reckless driving, binge eating).
- Recurrent suicidal behaviour, threats, or self-harm.
- Intense mood swings lasting hours to a few days.
- Chronic feelings of emptiness.
- Intense, inappropriate anger.
- Temporary stress-related paranoid thoughts or dissociation.
Causes
Genetic temperament plus childhood abuse, neglect or unstable caregiving, and disturbed emotion regulation.
Management
- Psychotherapy is the main treatment: dialectical behaviour therapy (DBT) by Marsha Linehan (mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness skills); mentalization-based therapy; schema therapy.
- Medicines for specific symptoms (mood stabilizer, antidepressant, short-term low-dose antipsychotic); no medicine treats BPD itself.
- Treatment of co-existing depression, substance use and eating disorders.
Nursing care
- Consistent boundaries and a team approach: the whole team gives the same limits and information to prevent splitting.
- Warm but professional, non-punitive, calm approach; be reliable and honest; keep appointments; plan endings carefully.
- Assess suicide and self-harm risk at every contact; take all threats seriously; ensure a safe environment; follow the safety plan; do not leave clients at high risk unobserved.
- Respond to self-harm with calm, matter-of-fact wound care and a later discussion, without blame or rewards for the behaviour.
- Teach distress-tolerance and emotion-regulation skills (paced breathing, grounding, contacting a support person, a written safety plan) and encourage problem-solving after the crisis.
- Set limits on manipulative or abusive behaviour; avoid power struggles; give praise for adaptive coping.
- Seek regular supervision and peer support to prevent burnout.
Q-18. Describe passive-aggressive personality disorder. Explain its features and nursing management.
Passive-aggressive (negativistic) personality is a pattern of indirect resistance to demands and expectations, and covert hostility, expressed through procrastination, inefficiency and stubbornness instead of open disagreement. Older DSM editions included it (as “negativistic personality disorder”); it is no longer an official diagnosis in DSM-5-TR or ICD-11, but the behaviour pattern is commonly met in practice and is part of the syllabus.
| Typical features | Examples |
|---|---|
| Passive resistance to tasks | Deliberately slow, “forgets”, makes errors, procrastinates |
| Sullen, argumentative, irritable | Sulks, mutters, sarcasm |
| Resentment of authority | Complains of being unappreciated or treated unfairly |
| Envy of others who are better off | Criticizes those in authority |
| Alternates between defiance and apology | Agrees verbally but does not comply |
Causes
Learned behaviour from controlling or punishing parenting where open anger was unsafe; low self-esteem; fear of conflict.
Nursing management
- Stay calm; do not respond to provocation; avoid power struggles and sarcasm.
- Give clear, specific expectations and agreed responsibilities; follow up consistently.
- Point out the behaviour and its effect without blame; ask the client to say directly what he or she feels or needs.
- Assertiveness training and anger-expression skills; role-play.
- Reinforce open, honest communication and completed tasks.
- Teach problem solving and stress management; group therapy.
- Team consistency; supervision for staff.
Q-19. Solve these short cases (made up).
Case 1. A young man says the neighbours speak about him through the wall and refuses food because “it is poisoned”. What should the nurse do?
Answer: Stay calm, do not argue or agree, acknowledge his fear, ensure food and fluids (sealed or shared food as per policy), assess safety and command hallucinations, give medicines as prescribed, reduce stimulation and involve the team.
Case 2. A client on haloperidol suddenly develops a twisted neck and eyes rolled upwards. What is it and what is done?
Answer: Acute dystonia. It is an emergency; call the doctor, give anticholinergic as ordered, reassure and stay with the client; record.
Case 3. A client on an antipsychotic has fever, muscle rigidity, confusion and a fast pulse. What should the nurse suspect?
Answer: Neuroleptic malignant syndrome. Withhold the drug, call the doctor immediately, monitor vital signs, cool, give fluids and arrange emergency transfer.
Case 4. A client with BPD tells a nurse, “You are the only one who understands me; the other staff are useless,” then later becomes angry with her. What is happening and what should the nurse do?
Answer: Idealization and devaluation (splitting). Stay professional, avoid taking sides, share concerns with the team, keep consistent limits, and discuss with the supervisor.
Q-20. Write the importance of this unit for a Post RN BSN nurse.
- Schizophrenia is a leading cause of long-term disability, so early recognition and good adherence make a large difference.
- Antipsychotic side effects can be dangerous (dystonia, NMS, metabolic disease) and nurses are the first to notice them.
- Consistent, respectful communication helps clients with delusions, hallucinations and personality disorders.
- Family education and community follow-up prevent relapse.
Conclusion: Schizophrenia and personality disorders are treatable conditions; safe use of antipsychotics, clear boundaries, and respectful communication are the nurse’s main tools.
Suggested references (the syllabus page lists topics only): Videbeck, S. L. Psychiatric-Mental Health Nursing (latest edition). Lippincott Williams & Wilkins.
Townsend, M. C. Essentials of Psychiatric Mental Health Nursing (latest edition). F. A. Davis.
World Health Organization. Mental health fact sheets and the ICD-11 classification (current versions).
American Psychiatric Association. DSM-5-TR (2022).
Source syllabus: LUMHS Post RN BSN Advance Concepts in Nursing-III (course syllabus) (original post dated May 4, 2017).
Series (Advance Concepts in Nursing-III, Course No. 715): Part 1: Unit I – Mental Health and Mental Illness. Part 2: Unit II (A) – Communication, Self and Anxiety-Related Disorders. Part 3: Unit II (B) – Mood Disorders and Family Therapy. Part 4: Unit III – Schizophrenia and Personality Disorders. Part 5: Unit IV (A) – Therapeutic Interventions, Suicide and Crisis. Part 6: Unit IV (B) – Ethical, Legal and Community Mental Health. Part 7: Clinical Objectives. Part 8: Learning Psychiatric Nursing – facts, skills, uses, benefits and hurdles.
Independent educational resource: POST RN BSN Nursing Resources is not affiliated with, endorsed by or an official publication of LUMHS or PNMC. Model answers are study aids; verify against your course notes and textbooks.
POST RN BSN Nursing Resources
0 Comments