1st Feb 2023
Previously, schizophrenia was categorized into five subtypes: paranoid, catatonic, disorganized, residual, and undifferentiated . In the most recent publication of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) , these five subtypes have been removed, due to concerns relating to the validity and stability of these diagnoses .
As such, disorganized schizophrenia is no longer a specific diagnosis, but the symptoms of disorganized schizophrenia and other types of schizophrenia are still used by physicians to form a diagnosis, based on the severity of the presenting symptoms.
Schizophrenia can present as a variety of symptoms, including:
According to the DSM-IV, for a diagnosis of disorganized schizophrenia, hallucinations and delusions may be present, but the primary symptoms would be disorganized speech and behavior . This could include saying bizarre things, shifting rapidly between topics during conversation, repeating words and phrases, or feeling often confused about things.
Another common symptom of disorganized schizophrenia is flat affect, meaning that the person will be expressionless and show inappropriate or unusual responses.
Symptoms of disorganized schizophrenia may include hallucinations, meaning that you may see, hear, feel, smell, or taste things that are not there, such as hearing voices; or delusions, meaning that you have strongly held beliefs that are not correct or based on any evidence, such as believing that the television is sending messages, or that people can hear your thoughts .
While delusions and hallucinations may be present in disorganized schizophrenia, the primary presenting symptoms will be related to a clear impairment in cognition and daily functioning, usually seen as disorganized thoughts and behavior. Symptoms of disorganized schizophrenia include :
The cause of schizophrenia is not known, but may be related to several factors, such as:
Research suggests that schizophrenia may be caused by changes in neurotransmitter levels, particularly dopamine and glutamate .
There is also evidence to suggest that people with schizophrenia have differences in their brain structure, including a decreased amount of gray matter, suggesting that it could be caused by impaired development of the brain .
Similarly, traumatic brain injury could cause an onset of psychosis or schizophrenia, also suggesting that brain structure can contribute to the development of the condition .
Schizophrenia is more common in those with a parent or close relative with the condition, than in those without. It is estimated that people with a parent or sibling with schizophrenia are six times more likely to develop the condition . However, a family history of schizophrenia does not definitely mean that the condition will develop.
Schizophrenia may be triggered by various social or environmental factors, such as stress, childhood trauma and abuse, social isolation, socioeconomic class, and complications during pregnancy and childbirth. These factors have been found, alone or in combination with others, to increase the risk of psychosis and schizophrenia .
Substance use, in particular the use of cannabis, has been found to increase the risk of psychosis. This risk is higher in those who use cannabis from a younger age, in large doses, and of a high frequency and regularity .
Similarly, some research suggests that cocaine, amphetamines, and alcohol can contribute to an increased risk of psychosis .
Antipsychotic medication is typically used in the treatment of all types of schizophrenia and can help alleviate most symptoms. Your doctor will initially prescribe a second-generation antipsychotic medication, such as olanzapine, aripiprazole, or risperidone.
People respond to medications differently, so what works for one person may not work for another. You may need to try more than one medication, or a combination of medications, before you find an effective treatment. Antidepressants and mood stabilizers may also be used to treat certain symptoms of schizophrenia.
If you have had limited success with two or more antipsychotic medications, you might be prescribed clozapine. It is a very effective medication for the treatment of schizophrenia, but can have severe side effects and risks associated, which is why it is not a first choice of medication, and requires careful monitoring, including regular blood tests .
Many antipsychotic medications can cause side effects of varying severity, which is one of the reasons that some people don’t take their medication regularly. Also, people with schizophrenia sometimes lack insight, meaning that they do not think they are unwell, so don’t think they require medication. Medication noncompliance can cause a relapse of symptoms .
It is important that you take your medication exactly as prescribed, as taking too much, missing doses, or suddenly stopping your medication can cause adverse effects and can worsen your condition.
There are various types of therapy that can be useful for the treatment of schizophrenia.
Cognitive behavioral therapy (CBT) can be helpful for adapting negative thoughts and behaviors, gaining insight about your condition, and preventing relapse .
Family therapy can be useful for some people, as it can help the family to better understand and manage their loved one’s condition, symptoms, and behavior .
Psychosocial treatments can help you to learn social skills, develop tools to manage your condition, understand the importance of your medication, and find support in others who have coped with similar experiences .
Schizophrenia is no longer diagnosed as one of five specific subtypes, but the symptoms of each subtype are still used in formulating diagnoses. Along with disorganized schizophrenia, the other four previously used subtypes were :
According to the DSM-IV , for a diagnosis of paranoid schizophrenia, delusions and/or hallucinations must be present. The person will be very focused on at least one specific delusion, which will typically be persecutory in nature, causing a belief that someone or something will do them harm.
This could be a voice, or voices, telling them they are being followed, watched, or poisoned, or they may see or hear concerning messages. As such, people with a diagnosis of paranoid schizophrenia will typically be very suspicious and untrusting of others, which may result in expressions of anger, fear, or withdrawal .
Catatonic schizophrenia involves abnormal psychomotor function. This can be an inability to move, excessive or hyperactive moments, or odd and unusual movements or postures .
A common symptom of catatonic schizophrenia is immobility, or stupor, which means that the person appears frozen in place, sometimes for hours or days, and can be in odd positions for long periods of time.
Other common symptoms are echolalia and echopraxia, which respectively mean mimicking other people’s words or mimicking other people’s actions .
People with a diagnosis of residual schizophrenia would have no prominent examples of positive symptoms, such as hallucinations, delusions, and disorganized speech, but there would be a clear disturbance in their cognition. They may experience negative symptoms and odd beliefs.
Undifferentiated schizophrenia was diagnosed when symptoms of schizophrenia were present, but the criteria for any of the other subtypes was not clearly met.