130. CCA Study Notes: Schizophrenia Spectrum Disorders and Client Support

The Big Picture

Schizophrenia spectrum disorders are mental health conditions that affect how a person thinks, understands what is real, and interacts with others. Some people hear voices that are not there. Others believe things that are not true or have trouble speaking clearly.

These conditions can affect everyday life, including work, relationships, and personal care. Symptoms vary from person to person.

As a Continuing Care Assistant (CCA), you can help by treating clients with understanding and respect. Knowing how to respond to unusual beliefs or experiences is an important part of providing support.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

What Are Schizophrenia Spectrum Disorders?

Schizophrenia spectrum disorders are a complex group of mental health conditions that affect approximately 1% of Canadians.

These conditions can involve changes in:

• Thinking: Thoughts may become disorganized or difficult to express.
• Perception: A person may experience things that are not real.
• Speech: Communication may become confusing or difficult to understand.
• Behaviour: Actions may become severely disorganized.
• Emotional expression: Facial expressions or other displays of emotion may become limited or appear dazed.
• Social activity: A person may withdraw from other people.

These changes can affect many parts of a person’s life, including work, school, social activities, family relationships, and self-care ⓘ.

When Does Schizophrenia Usually Begin?

Schizophrenia usually begins between the late teenage years and the mid-30s.

Men and women are affected equally, but symptoms tend to begin earlier in men.

Group	Usual Age of Onset
Men	18 to 25 years
Women	25 to 35 years

Other important facts:

• Symptoms can begin suddenly.
• In most cases, symptoms develop gradually.
• Late-onset schizophrenia has been reported in people older than 45.

Number to remember: Men and women are affected equally, but the usual age of onset differs.

What Causes Schizophrenia?

The exact cause of schizophrenia is not established. There are several theories about what may contribute to the condition.

One leading theory suggests that people with schizophrenia may have a biochemical imbalance, meaning an imbalance involving chemicals in the body.

Another theory suggests that substance and drug abuse may trigger underlying genetic vulnerabilities ⓘ in some people.

These are proposed explanations, not established causes for every person.

Understanding Psychosis

Psychosis is a mental state in which a person’s perception of reality is impaired.

In simple terms, the person has difficulty recognizing what is real.

People with schizophrenia spectrum disorders may experience psychosis along with other changes in thinking, communication, and behaviour.

Understanding Delusions

A delusion is a fixed, false belief that is not based on reality.

The person believes something is true even though it is not.

Two important types of delusions are delusions of grandeur and delusions of persecution.

Delusions of Grandeur

Delusions of grandeur involve false, exaggerated beliefs about a person’s importance, talents, or wealth.

For example, a person might believe they hold an important national leadership position or are a goddess.

The main idea is that the person has an unrealistic belief about their own importance or abilities.

Delusions of Persecution

Delusions of persecution involve false beliefs that someone is mistreating, abusing, or harassing the person.

For example, someone might believe that a neighbour intends to kill them when this is not true.

The main idea is that the person believes someone is trying to harm or mistreat them.

Remember the difference:

• Grandeur: False beliefs about being especially important, talented, or wealthy.
• Persecution: False beliefs about being mistreated, threatened, or harassed.

Understanding Hallucinations

A hallucination happens when a person experiences something through their senses that is not real.

Hallucinations may involve:

• Seeing: Seeing faces that are not there.
• Hearing: Hearing voices that are not there.
• Smelling: Smelling something that is not present.
• Tasting: Tasting something that is not present.
• Feeling: Feeling something that is not real.

Hallucinations can be different for each person.

Some people experience frightening hallucinations. They may hear voices telling them to harm themselves or other people.

Other people may experience hallucinations that seem friendly or peaceful.

Key fact: A hallucination does not always involve hearing voices. It can involve any of the five senses.

Understanding Paranoia

Paranoia means extreme suspicion about a person or situation.

A person experiencing paranoia may believe that someone is:

• Watching them.
• Following them.
• Controlling them.

Paranoia may also involve delusions of persecution.

The important connection is that paranoia involves extreme suspicion, while delusions of persecution involve false beliefs about being mistreated, abused, or harassed.

Changes in Thinking and Communication

Schizophrenia can make it difficult for a person to organize thoughts and communicate clearly.

Possible changes include:

• Disorganized thinking: Thoughts become difficult to organize.
• Disorganized speech: Speech becomes confusing or frequently incoherent, meaning it does not make sense.
• Rambling: The person speaks in a wandering or difficult-to-follow way.
• Repeating words: The person repeats what someone else has said.
• Unclear communication: Speech becomes so disorganized that other people cannot understand it.

A person may also respond in ways that do not fit the situation.

These difficulties can affect the person’s ability to communicate and relate to others.

Changes in Behaviour and Emotional Expression

Some people with schizophrenia have severely disorganized behaviour.

Others show fewer emotional expressions or appear dazed.

A person with severe schizophrenia may also withdraw from other people and the surrounding world.

For example, someone may sit alone for hours without:

• Moving.
• Speaking.
• Responding to other people.

These behaviours can occur alongside other symptoms, such as disorganized thoughts or hallucinations.

How Schizophrenia Can Change Over Time

Schizophrenia does not follow exactly the same pattern in every person.

Some people experience one severe psychotic episode that lasts for a month or longer. A psychotic episode is a period when a person experiences psychosis.

Most people with schizophrenia experience signs and symptoms throughout their lives.

They may also experience periods of remission.

Remission means that the signs and symptoms of a disease become less noticeable or disappear for a period.

Important difference:

• Ongoing symptoms: Signs and symptoms continue over time.
• Remission: Signs and symptoms lessen or disappear.

Without treatment, schizophrenia causes severe mental impairment. People may have serious difficulties communicating, relating to others, and responding appropriately.

Supporting Clients With Schizophrenia Spectrum Disorders

Clients with schizophrenia spectrum disorders may need support when symptoms affect their thoughts, communication, or behaviour.

Your approach should be respectful, understanding, and focused on the client’s needs.

Help the Client Focus on One Activity

Focus on one task or activity at a time.

This helps the client concentrate without having to manage several activities at once.

Keep your attention on the current activity rather than introducing multiple tasks together.

Be Aware of Your Nonverbal Communication

Nonverbal communication includes messages conveyed through body language and facial expressions.

Be careful about how your movements and facial expressions might appear to the client.

Avoid body language or facial expressions that could seem threatening.

The goal is to communicate in a way that does not make the client feel threatened.

Do Not Argue About Delusions or Hallucinations

A delusion or hallucination may seem real to the client.

Do not argue with the client about whether the experience is real.

You may gently suggest that a delusion is not real, but avoid arguing or confronting the client.

This approach respects the fact that the client experiences the belief as real.

Do Not Pretend the Experience Is Real

Although you should avoid arguing, you should not pretend that a delusion or hallucination is real.

Instead:

• Comfort the client.
• Show empathy.
• Avoid pretending that the experience is real.

Empathy means showing understanding and sensitivity toward another person’s feelings.

You can be kind and supportive without agreeing with a false belief or experience.

Tell Your Supervisor About Delusions or Hallucinations

Report: Tell your supervisor when a client is having a delusion or hallucination.

This includes situations where the client describes something they falsely believe or something they see, hear, or otherwise sense that is not real.

Your responsibility is to provide appropriate support and inform your supervisor.

Use Distraction to Help the Client

Distraction can help you avoid disturbing a client who is experiencing symptoms.

Supported examples include:

• Playing music.
• Taking the client for a walk.

These activities can provide something else for the client to focus on.

The important idea is to offer a simple distraction rather than arguing about the client’s experience.

Common Mix-Ups

Some terms describe experiences that can sound similar. Use these differences to keep them clear.

Wrong Idea	Better Idea
A delusion means hearing or seeing something unreal.	A delusion is a false belief. A hallucination involves sensing something unreal.
Delusions of grandeur involve believing someone wants to harm you.	Grandeur involves exaggerated self-importance. Persecution involves false beliefs about mistreatment or harm.
Paranoia always means seeing or hearing something unreal.	Paranoia means extreme suspicion about a person or situation.