Norma, a 42-year-old client with a diagnosis of chronic undifferentiated schizophrenia lives in a rooming house that has a weekly nursing clinic. She scratches while she tells nurse she feels creatures eating away at her skin. Which of following interventions should be done first?

Correct Answer: C. Assess for possible physical problems such as rash

Clients with schizophrenia generally have poor visceral recognition because they live so fully in their fantasy world. They need to have an in-depth assessment of physical complaints that may spill over into their delusional symptoms. Over half of the patients have significant comorbidities, both psychiatric and medical, making it one of the leading causes of disability worldwide. The diagnosis correlates with a 20% reduction in life expectancy, with up to 40% of deaths attributed to suicide.

• Option A: Talking with the client won’t provide an assessment of his itching. A thorough risk assessment must also be undertaken to determine the risk of harm to self and others. The first schizophrenic episode usually occurs during early adulthood or late adolescence. Individuals often lack insight at this stage; therefore few will present directly to seek help for their psychotic symptoms.
• Option B: Itching isn’t an adverse reaction of antipsychotic drugs. Common presentations include a relative noticing social withdrawal, personality changes or uncharacteristic behavior; deliberate self-harm or suicide attempts; calling the police to report their delusional symptoms or referral via the criminal justice system. The use of screening tools such as COPS (Criteria of Prodromal Syndromes), SIPS (Structured Interview for Prodromal Syndromes) and PACE (Personal Assessment and Crisis Evaluation Clinic) has been shown to increase the detection rate of schizophrenia in premorbid states although there is controversy surrounding indicating treatment at this stage.
• Option D: Calling the physician to get the client’s medication increased doesn’t address his physical complaints. After conducting a full psychiatric history, it is imperative to conduct a thorough systems review and a mental state examination where appearance, behavior, mood, speech, cognition, and insight need to be assessed, alongside determining evidence of perceptual delusions or formal thought disorders.