Types of Schizophrenia
Schizophrenia is a long-term condition that can impact emotions, cognitive abilities, and interpersonal relationships.
It’s possible for a person to experience symptoms that fall under multiple subtypes of schizophrenia throughout their illness.
Symptoms may be episodic and include:
- Hallucinations
- Delusions
- Disordered thinking
- Abnormal movements
- A lack of emotional expression, also known as “flat affect“
The symptoms of schizophrenia will help a doctor determine the type of schizophrenia a person has.
In the past, subtypes of schizophrenia were defined based on the most prominent symptoms displayed by an individual. However, the DSM-5 no longer uses these subtypes for diagnosis.
While clinicians may not use subtypes for diagnosis, they may still be helpful in guiding treatment plans, and the DSM-IV-TR may be used as an additional resource.
While these subtypes are no longer used for clinical diagnosis, they may still be used by healthcare professionals to help inform and understand a diagnosis.
Paranoid subtype
To diagnose the paranoid subtype (also referred to as paranoid schizophrenia), doctors look for symptoms such as auditory hallucinations or delusions related to persecution or conspiracy.
During the time that subtypes were used for diagnosis, this was the most prevalent subtype.
The symptoms of the paranoid subtype overlap with those of other subtypes and can include hallucinations, delusions, difficulties with speech and language, echolalia, problems with concentration, behavioral issues such as aggression, and a lack of emotional expression or flat affect.
The paranoid subtype of schizophrenia is associated with better social and occupational functioning compared to other subtypes.
It is unclear why, but some individuals with this subtype develop symptoms later in life and have already achieved a higher level of functioning before their illness.
The person’s temperament and behavior are typically related to their delusions and hallucinations, and they often form a consistent narrative. For instance, someone who believes they are being persecuted may exhibit anger easily.
Disorganized or hebephrenic subtype
The primary symptom of this subtype is disorganization of thought processes, while hallucinations and delusions may be less severe and not necessarily connected to each other. However, there may still be some signs of these symptoms.
Symptoms of the disorganized subtype of schizophrenia include problems with communication and thought processes, lack of emotional response, and inappropriate emotional reactions. Daily activities such as work or social relationships may be difficult to manage for people with these symptoms.
Hallucinations and delusions may also be present but are typically less prominent than disorganized behavior.
Daily tasks like dressing, bathing, or brushing teeth may pose difficulties for individuals with disorganized schizophrenia.
Emotions can also be significantly affected, with some appearing to have little or no emotions, which is referred to as a blunted or flat affect by mental health professionals.
To put it differently, individuals with this subtype may display emotions that are either unstable or do not match the context.
They may also struggle with effective communication, as their speech can become difficult to understand due to disorganized thinking, leading to nonsensical sentences or jumbled speech.
Catatonic subtype
The predominant clinical features of the catatonic subtype of schizophrenia involve difficulties with movement and responding to other people or everyday situations. Symptoms include:
- a lack of movement, known as catatonic immobility
- repetitive or purposeless movements, speech, or actions, known as stereotypy
- echoing or parroting speech, known as echolalia
- lack of speech, known as mutism
- waxy flexibility, or maintaining the body position they are placed in by another person.
Individuals experiencing symptoms of this subtype may experience a reduction in activity, to the extent of voluntary movement ceasing.
As a result, they may appear blind, deaf, or unable to speak, as they may remain stiff or frozen when others try to interact with them. On the other hand, some may experience an increase in activity, referred to as catatonic excitement. These symptoms can be observed in other conditions as well.
Additionally, individuals with this subtype may involuntarily assume unusual body positions, facial expressions, or arm and leg movements.
Undifferentiated subtype
The undifferentiated subtype of schizophrenia was used to diagnose people who had symptoms that were not clearly defined or specific enough to fit into a particular subtype.
Symptoms of this subtype may vary and fluctuate, making it difficult to classify into a specific subtype. People with this subtype may also display symptoms that could fit into multiple subtypes.
Since the removal of specific subtypes, this subtype is used to indicate the presence of various symptoms.
Residual subtype
In this subtype, the person’s symptoms have decreased in severity or are no longer prominent. They may have some mild symptoms or unusual thought patterns, but these do not significantly disrupt their daily life.
However, the use of this subtype is limited as symptoms can still fluctuate over time.
Outlook
Schizophrenia cannot be prevented, but it can be effectively managed with treatment, particularly when symptoms are recognized and treated early.
The impact of different types of symptoms can vary among individuals. While some may require hospitalization and intense care, others may be able to continue their normal activities such as work and social life.
Most people with schizophrenia fall somewhere in between these extremes.
The typical approach for treating schizophrenia involves the use of medication and may also involve other types of therapy, such as emotional skills training, family therapy, specialized forms of cognitive-behavioral therapy (CBT), and community integration and job training.
Each person’s symptoms and needs are unique, so it’s important to work with your healthcare team to develop a personalized treatment plan that works best for you.
Research has shown that current treatments can be effective, although some subtypes may respond better than others. However, there is hope for improving treatment for all subtypes. Some researchers are optimistic about the possibility of finding a cure in the future.
4 sources
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- Mattila T, et al. (2015). Impact of DSM-5 changes on the diagnosis and acute treatment of schizophrenia.
Patel KR, et al. (2014). Schizophrenia: Overview and treatment options.
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