Schizophrenia

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Schizophrenia Subtypes

As schizophrenia progresses, its symptoms can change. Its course is categorized clinically by whatever type of behavior is prominent during an episode. The following five main subtypes are used to classify schizophrenia:

• Catatonic
• Paranoid
• Disorganized
• Undifferentiated
• Residual

People with catatonic type assume peculiar postures and are usually speechless. They may be both rigid and motionless, or they may seem agitated and move around excessively, but always without external stimulus. Catatonic people may also have strange facial expressions, may mimic the behavior of others, and may repeat words that others say. Catatonic behavior is also seen in mood disorders, like bipolar disorder and major depressive disorder, and occasionally in diseases of the central nervous system, like Parkinson's disease.

Paranoid schizophrenia is marked primarily by delusions that follow a theme, like persecution or grandeur. Auditory hallucinations may accompany a delusion and are, therefore, usually related to its theme. Symptoms common to other subtypes, like disorganized speech and flattened affect, are not usually prominent in episodes of paranoia, but anger, irritability, and extreme anxiety are. People suffering from paranoid delusions become particularly preoccupied with them and may be especially prone to violence.

Interestingly, people with paranoid schizophrenia may experience less dysfunction than people with other subtypes. They are often able to live, work, and care for themselves. The onset of paranoid schizophrenia is often later in life, and, with time, it may characterize most or all episodes.

Disorganized type, which is marked by disorganized speech, behavior, and flattened affect is particularly disruptive. The disorganized episode (also known as hebephrenic schizophrenia) often features fragmented speech and inappropriate or unexpected behavior that does not reflect ideas expressed verbally. Strange mannerisms, gestures, and surprising behavior are common. This type of schizophrenia typically causes significant dysfunction in daily life, self-care, and interaction with others, as well as notable thought disturbance and loss of goal-directed behavior. People in the midst of a disorganized episode show no catatonic signs.

Undifferentiated schizophrenia is the type given to a lack of catatonia, paranoia, or disorganized speech. Undifferentiated schizophrenia might resemble other illnesses, including neurological disorders. However, people suffering from nonpsychiatric diseases typically have insight into their condition and they understand the medical basis for its presence.

Finally, the residual type of schizophrenia is diagnosed when positive symptoms like delusions, hallucinations, and grossly disorganized behavior have disappeared. Negative symptoms remain and may be interrupted only briefly by mildly disorganized speech or strange behavior. When delusions or hallucinations occur, even if infrequently, they are not serious enough to cause severe dysfunction. The residual evidence of schizophrenia is apparent by the presence of a flattened affect, loose speech, and a general loss of goal-directed interests. Residual symptoms can last indefinitely, or they can lead to complete recovery, though this is rare.

Generally, 20% of people experience significantly improved function, 40% improve with intermittent periods of impairment, and 40% remain severely affected or incapacitated. Variation depends on adherence to treatment and the factors that seem to prefigure the course of the disease.

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