CCFP priority topic 85 of 105
Schizophrenia on the CCFP exam
9 key features, the mistakes that cost marks, and a practice question.
Checked by a Canadian family physician, MD, CCFP. Updated October 20, 2026.
What the exam tests
Key features
The CFPC’s 9 key features for Schizophrenia. Each one below has how the exam asks it, the common mistakes and the approach.
Practice question
Try one before you read
A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.
Key feature 1 of 9
Psychosis in a teen
When a teen or young adult starts acting differently, include psychosis and revisit it over time.
CFPC skill Clinical reasoningPhase Hypothesis generation, diagnosisSources Choosing Wisely Canada
On the exam
A 17-year-old is failing school, has dropped friends and stays in their room. Expect a short menu (pick several from a list) of questions to ask.
Pick the questions that find psychosis.
Common mistakes
Reading a strange act, like foil over the vents, as a compulsion or a teen phase. Ask why: a fixed fear of being gassed is a delusion.
Approach
- Ask directly about voices, odd beliefs, and feeling watched or controlled. Many young people will not mention these unless asked.
- Look for a slow slide: falling grades, lost friends, poor self-care, odd speech.
- Keep the list open: drug use, depression with psychosis, bipolar disorder, a medical cause.
- Do not order a routine brain scan in a first episode of psychosis. Scan if signs point to a brain cause, such as headaches, vomiting, seizures or a late onset.
- See the patient again soon. Revisit the diagnosis as symptoms, drug use and function change.
Key feature 2 of 9
The stable review
In a patient who seems well, review a fixed set of areas at regular visits, with family input.
CFPC skill Clinical reasoningPhase HistorySources Health Canada
On the exam
A man in his sixties, stable on a long-acting (depot) injection for decades, comes for review. Expect a short menu (pick several from a list).
Pick what to ask at this visit.
Common mistakes
Retaking the whole first-visit history: onset, childhood, family history, old admissions. A settled diagnosis needs today's status, not the story of how it began.
Approach
- Ask about voices and odd beliefs. Ask too about flat mood, low drive and pulling away from people.
- Ask how he manages day to day: meals, money, hygiene, housing, friends, work.
- Ask about thoughts of harming himself or others. Suicide is a real risk in psychosis.
- Ask whether he takes his medicine, and about side effects: weight, stiffness, restlessness, sleepiness, sexual problems.
- Ask about alcohol, cannabis, other drugs and tobacco.
- Check that he can still weigh and make his own treatment choices. In older patients, ask about falls each time.
- With his consent, ask family or carers what they have noticed.
Key feature 3 of 9
Limits of privacy
Tell a patient with psychosis, and the family, when you may have to share what is said.
CFPC skill Professionalism, communicationPhase Treatment
On the exam
A guarded young man wants a secret kept about his neighbour. His mother waits outside. Expect one best answer.
Choose what to say first.
Common mistakes
Promising full secrecy to keep his trust. Or telling his mother everything because she cares for him: he is an adult with his own privacy.
Approach
- Before he says more, explain what stays private and what may not.
- Name the limits: a serious risk of harm to him or to someone else, and reports the law requires.
- Psychosis does not cancel his privacy. The law sets the limits, not the diagnosis.
- Ask what he will let you share with his family.
- Tell the family the same rules. You can listen to them, but you share only with his consent or when the law allows.
- If you must share, give only what reduces the risk, and write down why.
Key feature 4 of 9
Ask about drugs
In anyone with psychotic symptoms, ask what drugs, alcohol and other substances they take.
CFPC skill Clinical reasoningPhase History
On the exam
A 22-year-old hears voices after a weekend of parties. Expect a short menu (pick several from a list) of questions to ask.
Pick the drug questions to ask.
Common mistakes
Blaming the drugs and sending the patient home once sober. Or skipping the question because the patient already has schizophrenia.
Approach
- Ask about cannabis, cocaine, methamphetamine, hallucinogens, alcohol and prescription drugs.
- Ask how much, how often and when last used. Ask about withdrawal.
- Ask calmly and without judging. Ask again at later visits.
- When the story is unclear, ask family or friends, with consent, what the patient has been using.
- Drugs can cause psychosis, unmask schizophrenia or bring on a relapse. Psychosis that lasts after the drug wears off needs a full assessment.
Key feature 5 of 9
Treat early, stay involved
Start care soon after psychosis appears, refer, and share the care, since speed may help recovery.
CFPC skill Clinical reasoning, communicationPhase Treatment, referralSources Choosing Wisely Canada
On the exam
A first episode of psychosis in a 19-year-old who is calm and safe. Expect a short menu (pick several from a list) of next steps.
Pick the steps for the first weeks.
Common mistakes
Waiting for the psychiatry letter before doing anything, or handing off care for good. Starting two antipsychotics, or a high dose, is wrong too.
Approach
- Refer quickly, to an early psychosis program if there is one nearby.
- Keep seeing the patient while waiting. Check safety, sleep, drug use and family support.
- Use one antipsychotic at a time, at an adequate dose, for an adequate trial.
- Do not start with a high dose or two antipsychotics together. Psychiatry uses them only in narrow cases, such as a partial response to clozapine.
- One of the trials should be a long-acting injection.
- After two failed trials, discuss clozapine with psychiatry.
- Agree who does what: psychiatry, case manager, family doctor.
Key feature 6 of 9
Why relapse now
When a patient with schizophrenia gets worse, check drugs, missed or troublesome medicine, and lost support.
CFPC skill Clinical reasoningPhase Hypothesis generation, diagnosisSources Choosing Wisely Canada
On the exam
A young man, well for years, returns with foil over his vents, sure he is being gassed, and no sleep. He drinks three energy drinks a day. Expect a short menu (pick several from a list).
Pick what to check as causes.
Common mistakes
Raising the dose of a drug he has stopped taking. Or blaming the energy drinks alone: they do not explain a fixed belief of being gassed.
Approach
- Ask, without blame, whether he takes his medicine and how much. Check pharmacy refills.
- Ask why he stopped: weight gain, sleepiness, sexual problems, restlessness, or feeling well.
- Restlessness from the drug (akathisia) can drive people to stop it. It looks like pacing and an inner urge to move.
- Ask about new or heavier use of cannabis, stimulants or alcohol.
- Ask what changed at home, at work or in housing: a move, a loss, a carer gone.
- If he stopped the drug, restart what worked. Do not add a second antipsychotic or push to a high dose.
| Cause | Clue | What to do |
|---|---|---|
| Stopped medicine | Missed refills, pills found at home | Ask why. Restart, and discuss a long-acting injection. |
| Side effects | Restless, stiff, weight gain, sexual problems | Treat it, or change the drug with psychiatry. |
| Drugs | New cannabis or stimulant use | Address the use. Offer addiction care. |
| Lost support | A move, a death, a carer gone | Bring in family, a case worker, housing help. |
Key feature 7 of 9
Involuntary care
When a patient with schizophrenia worsens, decide whether the law allows care against their will, explain it, and stay involved.
CFPC skill Clinical reasoning, professionalism, communication, patient-centred approachPhase Diagnosis, treatment, referral, follow-up
On the exam
A calm man, six weeks off his antipsychotic, threatens a neighbour and refuses admission. Expect one best answer.
Choose the next step.
Common mistakes
Sending him home with his mother, or sedating him by injection without legal authority. A parent cannot consent to detaining an adult.
Approach
- Know your province's mental health act. Its tests centre on a mental disorder, serious risk of harm or decline, and voluntary care that will not work.
- Offer voluntary admission first. If he refuses and the risk is serious, start an involuntary assessment.
- Assess his capacity to accept or refuse treatment as a separate question. Detention and treatment are different decisions.
- Tell him plainly what is happening, why, and what his rights are.
- Sedation against his will needs legal authority. Calm refusal is not an emergency.
- Tell him you remain his family doctor. Stay in touch with the hospital team.
Key feature 8 of 9
Drug harms
Spot and manage the serious harms of antipsychotics, such as fever with rigidity, late movement problems and metabolic change.
CFPC skill Clinical reasoningPhase Treatment, diagnosisSources Health Canada
On the exam
A 68-year-old man on a long-acting haloperidol injection for decades, also on amlodipine, a statin and metformin, has new lip and tongue movements. Expect one best answer.
Choose the best management.
Common mistakes
Blaming his amlodipine, statin or metformin. Or raising the haloperidol dose: it hides the late movement problem (tardive dyskinesia) while adding to the exposure that caused it.
Approach
- Tardive dyskinesia means repeated, involuntary movements, often of the mouth, tongue or face. It can be permanent.
- Its risk rises with years of use and total dose. It is most common in older adults, above all older women.
- Use the lowest dose that works and review the need for the drug often. Stopping may help, but some patients still need it.
- Neuroleptic malignant syndrome: fever, rigid muscles, confusion, and unstable pulse and blood pressure. A muscle enzyme in the blood, creatine kinase, may be high.
- For that syndrome, stop all antipsychotics at once. The patient needs hospital care and close monitoring.
- Check weight and blood glucose before starting and regularly after, in every patient. Test sooner if thirst or frequent urination appear.
| Harm | Looks like | Do |
|---|---|---|
| Neuroleptic malignant syndrome | Fever, rigidity, confusion, unstable pulse and blood pressure, high creatine kinase | Stop all antipsychotics. Hospital care and close monitoring. |
| Tardive dyskinesia | Repeated mouth, tongue or face movements, after long use | Lowest dose that works. Review the need for the drug. Raising the dose only hides it. |
| Metabolic harm | Weight gain, high blood sugar, worse lipids | Check weight and blood glucose at the start and regularly after. Test sooner if thirst or frequent urination appear. |
| Low white cells | Fever or infection, falling infection-fighting white cells (neutrophils) | Stop the drug if neutrophils fall below 1 × 10⁹/L. Clozapine has its own blood-test rules. |
Key feature 9 of 9
Life beyond pills
Put housing, income, family help, disability benefits and job support into the care plan.
CFPC skill Patient-centred approach, selectivityPhase Treatment, referral
On the exam
A 30-year-old, stable on medicine, has lost a job and faces eviction. Expect a short menu (pick several from a list) of supports.
Pick the supports to arrange.
Common mistakes
A visit about doses and blood work only. Or deciding that a person with schizophrenia cannot work, when work may be possible with support.
Approach
- Ask about housing, food, income and debts at each review.
- Help with disability benefit forms. Your notes on daily function carry weight.
- Refer to supported job or school programs if the patient wants to work or study.
- Involve family, with consent. Offer family education and support for carers.
- Link the patient with a case manager or community mental health team.
- Ask about friends and loneliness. Peer support groups can help.
Flashcards
Answer it first, then check.
KF 1Is a brain scan routine in a first episode of psychosis?
No. Scan when signs point to a brain cause, such as headaches, vomiting, seizures or a later onset. Source: Choosing Wisely Canada
KF 2Name four areas to check at a stable schizophrenia review.
Any four of: symptoms, daily function, risk of harm, medicine and side effects, drug use, capacity.
KF 3An adult patient's mother asks what he told you. What can you share?
Only what he agrees to, unless the law allows sharing to prevent serious harm.
KF 5Two antipsychotic trials have failed. Which drug do you discuss next?
Clozapine, with psychiatry. One earlier trial should have been a long-acting injection. Source: Choosing Wisely Canada
KF 6He relapsed after stopping his antipsychotic. Do you raise the dose?
No. Restart the drug that kept him well, building back up if he has been off it a while. Find out why he stopped. Source: Health Canada
KF 7He refuses admission and threatens a neighbour. Can his mother consent to detention?
No. Detention follows the provincial mental health act, not a family member's consent.
KF 8Fever, rigid muscles and confusion on haloperidol. What do you do first?
Think of neuroleptic malignant syndrome. Stop all antipsychotics and send the patient to hospital. Source: Health Canada
KF 8Who faces the highest risk of tardive dyskinesia?
Older adults, above all older women, and those with years of use and high total doses. Source: Health Canada
FAQ
Does the exam expect a specific antipsychotic?
No single drug. Know the rules: one antipsychotic at a time, no routine high doses or pairs, one long-acting injection trial, and clozapine after two failed trials.
Which mental health act applies?
Your province's or territory's. Each has its own tests and forms. Learn the one where you will practise, including who can sign a form and for how long it lasts.
Can I talk to the family without the patient's consent?
You can listen to them. You share the patient's details only with consent, or when the law allows it, such as a serious risk of harm to someone.
Am I still involved once a psychiatrist admits the patient?
Yes. Tell the patient you remain their doctor. Share what you know with the hospital team, and book a visit soon after discharge.
Sources
Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.
Last reviewed October 20, 2026For exam study. Not advice for a patient in front of you.
- Assessment Objectives for Certification in Family Medicine, 2nd editionCollege of Family Physicians of Canada · 2020
- Choosing Wisely recommendationsChoosing Wisely Canada
- Drug Product DatabaseHealth Canada