Types of Schizophrenia

Schizophrenia is often referred to as a mental illness, a brain disorder, and a psychiatric disorder. It is characterized by episodes of psychosis in which a person disconnects from reality and experiences hallucinations, delusions, racing thoughts, disorganized thoughts and speech, and changes in emotional expression, behaviors and affect.

Exactly what causes schizophrenia is not known, but family history is a major predictor. Someone with a close relative with schizophrenia is at a greater risk of also being diagnosed.

A mental health professional uses diagnostic criteria from the DSM-V, the guide used by psychiatrists, psychologists and therapists, and a psychiatric evaluation to diagnose a patient with schizophrenia.

Treatment for this condition usually includes the use of medications called antipsychotics as well as psychotherapy.

Schizophrenia types include those that are characterized by paranoia, disorganized thoughts and speech, catatonia, a mixed set of symptoms, and symptoms that are milder. There are also disorders that fall outside of the schizophrenia spectrum but are related, like schizoaffective disorder and schizophreniform disorder. All of these conditions are very serious and require a professional diagnosis and treatment. Schizophrenia is manageable in most people and with the right treatment most patients are able to return to a more stable and independent lifestyle.

Schizophrenia types were outlined with diagnostic criteria in the previous version of the DSM, the fourth edition. In the newest edition there are no longer official types, but many professionals still use the former categories to better describe patients. While there are characteristic symptoms of schizophrenia, each individual experiences this condition in a unique way, and it is useful to have more specific subtypes to reference each patient. The types of schizophrenia previously outlined in the diagnostic manual are:

• Paranoid
• Disorganized
• Catatonic
• Undifferentiated
• Residual

The most common and prominent symptom of paranoid schizophrenia is the presence of delusions and hallucinations, known as positive symptoms because they are not normally present in someone without this condition. Hallucinations may be visual, but in this type of schizophrenia they are more often auditory. Hearing voices the person believes to be real, but that no one else can hear, is typical.

Delusional thoughts are also typical with this subtype and are usually paranoid. For instance, a person with paranoid schizophrenia may believe in conspiracy theories or that someone is out to get them, in spite of evidence to the contrary. The delusions and hallucinations that someone experiences are often thematic: government conspiracies, persecution, and so on.

Paranoid schizophrenics are often better able to live normal lives or to appear normal to peers and acquaintances as compared to other types of schizophrenia. The age of onset is typically older, so the explanation may be that these people have learned how to function reasonably well and to hide their delusional thoughts and beliefs.

In someone with disorganized schizophrenia, the most prominent symptom type is disorganized thoughts. There may be hallucinations and delusions as well, but these are not as severe as in someone with paranoid schizophrenia. Disorganized thoughts lead to disorganized communication and behaviors. Speech and behaviors may be appropriate, and speech may even be so disorganized as to be at times incomprehensible.

Also characteristic of someone with this subtype is impaired emotional processing and expression. This kind of patient may seem emotionally unstable or inappropriate. They do not always exhibit the correct or acceptable emotional response in ordinary situations. This is called flat affect if there is no emotional response or there is less response than what is typically expected. This is a negative symptom type because of the absence of a normal response. But the response may also be the opposite of what is expected, such as laughing at a sad event.

Catatonic schizophrenia is largely characterized by disordered movements. A person may range from completely inactive to hyperactive. These states can be extreme, such as catatonic stupor in which a person barely moves at all, or the opposite: catatonic excitement with excessive movement. Other possible symptoms of catatonic schizophrenia include:

• Repetitive movements,
• Resistance to changing appearance,
• Holding a position or pose for an extended period of time,
• Assuming unusual positions of the body, limbs, or facial expressions
• And mimicking another person, in what they say, how they move, or both.

In the previous categorization scheme, a person would be diagnosed as having undifferentiated schizophrenia if he or she did not adequately fit into any of the above three subtypes. Someone diagnosed this way may have more moderate symptoms, may exhibit a combination of all the symptoms prominently, or may even cycle between different symptoms with delusions prominent for a period followed by a period of catatonia, for instance.

It is no longer clinically official, but it is still useful for mental health professionals to refer to a patient as undifferentiated if he or she has a mix of symptoms or changing symptoms. It helps to describe the state of the patient better rather than simply giving a diagnosis of schizophrenia.

A diagnosis of residual schizophrenia is reserved for someone who has no prominent symptoms. This may be a patient who was previously diagnosed with schizophrenia but whose symptoms have become significantly less severe, or it may be someone who never had severe symptoms. This person may experience any variety of schizophrenic symptoms—hallucinations, delusions, disorganized thoughts, or catatonia—but they are not severe or prominent. Residual schizophrenia has the potential to worsen.

In the latest edition of the DSM there are diagnostic criteria for a condition called schizoaffective disorder, sometimes called bipolar schizophrenia, which was previously described as more of a subtype of schizophrenia or mood disorders. Schizoaffective disorder is a combination of schizophrenia and either bipolar disorder or depression. A person with this diagnosis experiences symptoms of both conditions, often at the same time. Possible symptoms of schizoaffective disorder include:

• Hallucinations and delusions
• Disorganized thoughts and communication
• Catatonia
• Flat affect
• Inappropriate emotional responses and behaviors
• Extreme sadness and hopelessness
• Shame and guilt
• Anger and irritability
• Lethargy and fatigue, loss of interest in activities
• Changes in appetite or sleep
• Difficulty concentrating and thinking
• Extreme euphoria
• Inflated sense of self-esteem and abilities
• Risky behaviors
• Rapid thoughts and speech
• Distractibility
• Agitation

With schizoaffective disorder, a person experiences schizophrenic symptoms and either the symptoms of depression or the symptoms of bipolar disorder. The latter is a condition that cycles between depression and mania, the symptoms that include euphoria, inflated self-esteem, risky behaviors, rapid speech, and distractibility.

A person with schizophrenic symptoms may be diagnosed with schizophreniform disorder depending on the duration of the symptoms. To be diagnosed with schizophrenia a patient must have persistent symptoms for six months or more. If the symptoms do not last that long—somewhere between one and six months—a diagnosis of schizophreniform disorder is appropriate.

All the symptoms of schizophrenia are possible with this condition, but they don’t persist for as long. The diagnosis is often considered provisional. If the patient recovers within the six-month period, the diagnosis holds, but if the symptoms persist the diagnosis is changed to schizophrenia. Another important difference is that to be diagnosed with schizophrenia the symptoms must cause significant impairment to a person’s life. This is not required for the provisional diagnosis.

The typical age of onset of schizophrenia is in the 20s to 30s for women and late teens to early 20s for men. It is very unusual to see symptoms of schizophrenia at a younger age, but it is possible. Most children diagnosed with this rare and severe condition are between the ages of seven and 13. The symptoms are the same as those seen in adults with schizophrenia, the main differences being the age of onset and the severity of the symptoms.

Although the symptoms are the same, because they are more severe and because they occur in children, childhood schizophrenia can cause serious developmental issues. The impact on how a child develops and behaves is deep and can have lasting effects. Diagnosis and treatment are essential to help a child improve in the long-term and to develop more normally. Diagnosis is difficult, though. The condition initially manifests as developmental delays, which can have a number of causes. It is also often confused with autism spectrum disorders.

The categorizations of schizophrenia types may no longer be official according to the latest edition of the diagnostic manual, but the typing is still important for mental health professionals and for patients. It helps professionals to better describe patients and to communicate with each other. For the patients themselves, and their families, understanding the type of schizophrenia being diagnosed helps them to better understand the condition, what it means, and what the goals of treatment will be.