Schizophrenia — Positive Symptoms & Nursing
A client hears a voice commanding them to stop eating because the food is poisoned. That's not anxiety or delirium — it's a positive symptom of schizophrenia, and your assessment response matters.
Core Concept
Positive symptoms represent an excess or distortion of normal function — things added to the client's experience that shouldn't be there. The four pillars are hallucinations, delusions, disorganized speech, and disorganized or catatonic behavior. Auditory hallucinations are by far the most common type in schizophrenia (heard in roughly 60–80% of cases); visual hallucinations should raise suspicion for an organic cause. Delusions are fixed, false beliefs — persecutory (someone is out to harm them), grandiose (they have special powers), and referential (the TV is sending them personal messages) are the most tested types. Disorganized speech includes loose associations (jumping between unrelated topics), tangentiality, neologisms (made-up words), and word salad. Disorganized behavior ranges from unpredictable agitation to catatonia. These symptoms typically respond to antipsychotic medication and are the primary targets during acute psychotic episodes. For assessment, you document the specific content of hallucinations — especially command hallucinations directing self-harm — because these dictate the safety plan.
Watch Out For
Don't confuse positive symptoms (additions: hallucinations, delusions) with negative symptoms (subtractions: flat affect, avolition, alogia). Students often mistake illusions (misperceptions of real stimuli) for hallucinations (perceptions without any external stimulus). A client who hears a voice with no source present has a hallucination; one who sees a coat rack and thinks it's a person has an illusion.
Clinical Pearl
Positive means 'plus' — something extra got added to reality. If the client is experiencing things that aren't there or believing things that aren't true, you're looking at positive symptoms.
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