Reviewed by Aaron Horn, LMFT
Schizophrenia is a chronic mental disorder that can be disabling and devastating. The condition disrupts the person’s perception of reality, actions, thoughts, emotions, and interaction. Affected people often find it challenging to maintain relationships and productivity at work or school. Although the condition still has no cure, patients can manage it with proper medical intervention and psychological therapy.
Schizophrenia is a type of psychosis with major symptoms like hallucinations, delusions, disorganized speech and behavior, and changes in personality and behavior. Patients are often unable to differentiate between what is real and imaginary. The condition, which affects approximately one percent of the US population, may lead people to lose touch with reality.
The severity of schizophrenia varies in patients. While some people may only experience one psychotic episode, others may have repeated episodes. Some may have a recurrent cycle of psychotic episodes and a time of remission when they are asymptomatic and can live normally. Others may have minimal improvements between psychotic episodes. Sometimes, patients may become a threat or danger to themselves or others.
Like many other mental disorders, it is possible to trace the cause of schizophrenia to factors like genetics and family history, changes in brain chemistry, and environmental factors. People often have a misconception that people with schizophrenia tend to get violent and have dual personalities.
According to the National Alliance on Mental illness, schizophrenia affects around 0.3% of the population. Both genders experience the disorder at the same rate, but men often show signs of the condition earlier than women. Estimates from the National Institutes of Health report that about 1.1% of American adults will get a diagnosis of schizophrenia at some point in their lives.
Although the condition can start at any age, it often occurs among men in their late teens or early 20s and the late 20s to early 30s for women. It is rare to see schizophrenia cases begin before the age of 12 or over the age of 40.
The Types Of Schizophrenia
The schizophrenia label does not define your existence, and the labels used by medical professionals tend to change with new studies into schizophrenia. A mental health professional may conclude that you are dealing with a specific form of schizophrenia. However, some doctors may choose not to diagnose subtypes after an overall schizophrenia diagnosis. Regardless of the doctor’s approach, they will address you as a person, consider the symptoms present, and how they affect you and your existence. This is more important than the label.
There are five known types of schizophrenia, all of which are classified by the symptoms exhibited by the person.
Paranoid schizophrenia is the most prevalent form of schizophrenia in the US and usually presents itself when the patient in their late teens or young adulthood years. Paranoid schizophrenia is like psychosis and is indicated by delusional thoughts such as the threat of bodily harm or separation from loved ones.
The symptoms of paranoid schizophrenia include unreasonable suspicion and mostly positive symptoms. (Positive in this sense means the symptoms are “in addition” to normal behavior and the condition and usually respond to medical intervention.) The patient may be obsessed with at least one form of delusion (often persecutory) or experience regular auditory hallucinations. On the other hand, other signs of schizophrenia, including disorganized behavior, disorganized speech, catatonic or flat affect, are absent or less obvious compared to the positive symptoms.
Undifferentiated schizophrenia is diagnosed when patients exhibit symptoms that do not fit into any of the specific types. The person may experience signs of catatonic, residual, and paranoid schizophrenia.
This is now regarded as a rare subtype of schizophrenia since the opinion is that it is mostly the consequence of untreated schizophrenia. It occurs less frequently among those with schizophrenia since early intervention and treatment has improved significantly. The signs include a remarkable reduction or exacerbation of movement with at least two of the following symptoms:
Someone with catatonic schizophrenia may be mostly immovable, keep a rigid posture, and fight any effort to move them. On another end, they may experience excessive, seemingly unnecessary movement. This may include echolalia (repeating other people’s words) and echopraxia (imitating other people’s movements). There may be a pattern to the movements, such as grimacing, strange posturing, or stereotypic movements such as hand waving, rocking, or nail-biting.
The symptoms are usually identified more through the person’s physical actions than their thoughts.People often confuse the condition as being under the influence of alcohol or drugs. Unnecessary fit of anger is another common symptom for those dealing with catatonic schizophrenia.
Disorganized schizophrenia is also known as “hebephrenia” and is indicated by signs of disorganized thoughts, speech, and behavior. Disorganized schizophrenia is more prevalent in teens and young adults who fall between ages 15 and 25. People with this subtype of schizophrenia often struggle with cognitive skills such as motor skills, memory, intelligence, and attention span. All of the symptoms of disorganized speech (such as incoherence, perseverance), disorganized behavior (such as trouble starting or completing tasks, trouble behaving appropriately in social settings), and flat or unfitting emotion (such as lack of facial expression, poor eye contact) must be present for the doctor to conclude on this subtype.
Residual schizophrenia is a minor form of schizophrenia indicated when positive symptoms of schizophrenia, such as delusions, disorganized behavior, and hallucinations, are not actively present in a patient. However, they may still exhibit negative symptoms (strange speech, trouble paying attention, social withdrawal, or absence of emotional expression) and at least two of the schizophrenia symptoms to a minor level (such as though distortion or strange beliefs). The person with residual schizophrenia could be shifting from the acute stage of schizophrenia to the remission stage or vice versa. Residual schizophrenia is hardly cyclical and may disappear or reoccur at any point.
This subtype should be differentiated from the residual stage of schizophrenia. Antipsychotic medications treat positive symptoms of schizophrenia effectively, but negative symptoms persist. Due to this phenomenon, schizophrenic patients who do not report signs of delusions or hallucinations are sometimes said to be in the residual or remission stage of schizophrenia. At this time, the patient may or may not be classified under the residual subtype.
Changes To The Classification Methods
Mental health professionals used to differentiate schizophrenia into the five main subtypes described above. However, with the 2013 release of the latest version of the Diagnostic and Statistical Manual of Mental disorders (DSM-V), the types have now been made redundant and replaced with what is now known as the schizophrenia spectrum.
The basics are still similar – schizophrenia causes psychosis, meaning people with the disorder cannot tell what is real apart from what is not. There is no change in the diagnostic criteria. However, the new designation of a schizophrenia spectrum, instead of the different types of schizophrenia, may be more effective for describing a condition that is actually multiple disorders. Schizophrenia is not one condition, but a clinical syndrome or a group of signs and symptoms.
Schizophrenia Spectrum Disorders
The focus on predominant symptoms has helped mental health experts differentiate and better help patients struggling with other mental disorders with symptoms like schizophrenia, presenting the schizophrenia spectrum of disorders.
Schizoaffective disorders are just like schizophrenia, but with a mood disorder added to the diagnosis. A patient is said to have a schizoaffective disorder if they are dealing with schizophrenia and a co-occurringcondition like depression or bipolar disorder. Due to this, the person with schizoaffective disorder will exhibit a wide variety of symptoms associated with comorbid conditions, like symptoms of depression, mania, and the general symptoms related to schizophrenia.
Aside from the hallucinations, delusions, or disorganized thoughts that come with schizophrenia, the patient deals with major mood episodes (manic or depressive.) This means they cannot be treated for psychotic disorder only; treatment must also be provided for a mood disorder. It is common to see people with schizoaffective disorder exhibit some of these signs regularly:
Depressive symptoms – Recurrent feelings of sadness, guilt, hopelessness, and worthlessness. The patient may find no joy or interest in activities they used to enjoy and experience a serious lack of energy or enthusiasm.
Mania symptoms – Increased activity in all areas of life, increased heart rate, rapid thoughts, poor sleeping patterns get easily agitated or distracted, speaking rapidly
General schizophrenia symptoms – lack of facial expressions, higher heart rate, delusions, hallucinations, and disorganized movements.
The schizophreniform disorder has similar features to schizophrenia, but the duration of symptoms does not last as long. The patient has dealt with the symptoms for more than a week but fewer than six months. Doctors consider the diagnosis as the first step toward a proper schizophrenia diagnosis, which entails recurrent signs of disturbance for up to six months.
Schizotypal Personality Disorder
Schizotypal personality disorder starts in early adulthood and is indicated by persistently poor social and interpersonal skills, strange behavior, discomfort with creating close personal relationships, as well as disrupted cognitive and perceptive functions. Someone with a schizotypal personality disorder may have notions of reference.
This is different from delusions of reference, where someone’s behavior changes due to a belief that something or someone is referring to them personally. For example, you think the newscaster on TV is trying to send a special message to you, so you stay fixated on the channel, trying to collect and decode the information. Notions of reference do not cause changed behavior. You may think that events are not just coincidences but are actually signs of what to expect in the future. However, your behavior remains the same. Also, superstitions, strange fantasies, and magical thinking are common with a schizotypal personality disorder.
Like schizophrenia, the patient may experience unfitting affect, paranoia, social anxiety, odd speech, or strange bodily sensations. Sometimes, a person may fit the criteria before the start of schizophrenia or other psychotic disorder, called premorbid.
Patients need to have experienced the symptoms of schizophrenia for six months or more to get a diagnosis. Schizophrenia is heterogeneous. People diagnosed on the schizophrenia spectrum may share the same symptoms or not, and their functioning and severity of the symptoms can vary as well.
Classifying schizophrenia along a spectrum does not alter treatment. Schizophrenia treatment has usually been based on the symptoms, not subtypes. Doctors are tasked with deciding what medications are appropriate for the specific person. This differentiates schizophrenia from conditions like cancer, where knowing the exact diagnosis is crucial for determining the proper treatment.
With this method, the goal is to treat every symptom as the focus for clinical assessment and care. Regardless of the symptoms the person has, whether it is related to facial expressions, movement, or relationships, the doctor will identify and attempt to find ways to deal with it.
Diagnosing The Type Of Schizophrenia
Up to one-third of people with schizophrenia do not think they have a problem. Many more do not seek medical help themselves, either due to lack of resources or for cultural reasons. Therefore, the problem only becomes noticed when erratic behavior or other issues cause a crisis. Family members, teachers, or police are often the ones who bring patients to the hospital.
Before admitting a patient, the mental health professional will determine if the patient presents a risk to themselves or others if they are capable of self-care and if hospital treatment will be beneficial.
If the patient is admitted, a medical professional will talk to them, assess their behavior, determine if the symptoms were due to drugs or alcohol use, check records of previous admissions, and discuss it with the family. At first, it seems that the patient is losing touch with reality. More time is necessary to assess every schizophrenia symptom. The symptoms include hearing voices, seeing visions or shadows, suspicion and distrust, and fixed but erroneous beliefs. During the hospital stay, the doctors will hope to notice enough symptoms to determine the type of schizophrenia. However, they may not see all the symptoms, so the first diagnosis may not be entirely accurate.
Schizophrenia responds better to a combination of medication and psychotherapy. Medications for schizophrenia usually include neuroleptics or antipsychotic drugs. The most suitable treatment options are cognitive enhancement therapy (or cognitive remediation therapy), social skills training, and individual psychotherapy. After undergoing treatment, the person usually learns to manage their symptoms better, especially as they transition from young adulthood.
In the absence of ongoing care, people with schizophrenia may be hospitalized several times, be fired from their job, or lose touch with their families. Early treatment, in every case, is crucial. In the case of hospitalization, the doctor will ensure that patient gets a good aftercare plan. Patients need to understand to know how to maintain good health by using their medication, staying off substance use, and joining community support groups. This will help them remain independent and be productive. The journey to diagnosis, treatment, and recovery can be challenging.
Schizophrenia is a mental health disorder that disrupts someone’s thoughts and behavior. The type and classification of schizophrenia have changed over time. Mental health professionals now use the general term schizophrenia to describe the condition and note the specific symptoms that the person is experiencing. Take an online schizophrenia assessment test here.