Health news
Health news top Health news

   Login  |  Register    
Health News Make AMN Your Home PageDiscussion BoardsAdvanced Search ToolMedical RSS/XML News FeedHealth news
You are here : Health.am > Health Centers > Mental Health - DepressionSchizophrenia • • Schizophrenia Diagnosis

Subtypes of Schizophrenia

Schizophrenia • • Schizophrenia DiagnosisMay 11, 2009

Once a patient is diagnosed with schizophrenia, a clinician considers his or her symptoms and determines a subtype diagnosis.

There are four subtypes of schizophrenia. Each subtype is based upon the types of symptoms the patient experiences.

Paranoid Type. Although psychotic by definition, patients with paranoid type usually appear the most “normal.”  That is, they are generally able to take care of themselves and their behavior and physical appearance often remains unaffected.

Patients with this type of schizophrenia may have intimate relationships with other people; it is not uncommon for them to marry and have children. Their primary symptoms include delusions and/or hallucinations. These patients do not experience any negative symptoms, meaning that they rarely lose the ability to talk clearly. Paranoid type generally develops later than other forms of schizophrenia and usually responds quite well to medication.

Disorganized Type. Patients with disorganized type are the most apparently psychotic. They are difficult to understand and their appearance makes them easy to identify. Someone with disorganized type schizophrenia might dress in weather-inappropriate clothing or appear disheveled and unkempt.

The disorganized type of schizophrenia was first recognized more than 100 years ago by a German psychiatrist, Ewald Hecker. In 1871, Hecker identified a group of patients who demonstrated extremely psychotic behaviors beginning in late adolescence or early adulthood. He called this pattern hebephrenia, originating from the Greek word hebe, meaning “youth.” Emilio, from the case study at the beginning of the chapter, appears to have schizophrenia, disorganized type.

Course and subtypes of schizophrenia

Both ICD-10 and DSM-IV provide broadly similar classifications of longitudinal course.  The subtypes of schizophrenia included in both ICD-10 and DSM-IV are paranoid, catatonic, undifferentiated and residual schizophrenia.  Hebephrenic schizophrenia is called disorganized type in DSM-IV.  The requirement for the subtypes is similar in both classification systems,  although they are more clearly operationalized in DSM-IV.

Common subtypes in ICD-10 and DSM-IV

  • Paranoid
  • Catatonic
  • Hebephrenic (disorganized in DSM-IV)
  • Residual
  • Undifferentiated

Additional subtypes in ICD-10

  • Simple
  • Postschizophrenic depression

ICD-10 also includes subcategories of simple schizophrenia and postschizophrenic depression as subtypes of schizophrenia.

ICD-10 clarifies retention of simple schizophrenia as a subtype of schizophrenia,  with the requirement of certain described features for at least 2 years because of its continued use in some countries and because of the uncertainty about its nature, which will require additional information for resolution.

Catatonic Type.  Patients with catatonic schizophrenia may have symptoms similar to patients with other subtypes of the disease but their physical movements make them different. Catatonic behavior is typically extremely slow, and these patients may appear as though they are moving in slow motion.

Sometimes these patients refuse to speak or even to acknowledge the presence of others. Such behaviors are called negativistic. Patients who have this form of schizophrenia may arrange their body in strange postures for extended periods of time.

They may lie curled up in a ball for hours, their muscles so tense that it is nearly impossible for other people to move them. They may involuntarily mimic the speech of others, a behavior called echolalia. Alternatively, these patients may involuntarily mimic the behaviors of others, a behavior called echopraxia. In very rare cases, a patient with schizophrenia, catatonic type, may display random hyperactivity,  purposeless exhibitions of manic-like behavior.

Undifferentiated Type. Schizophrenia, undifferentiated type is a category used for patients who do not meet the criteria for any other subtype. That is, these patients may meet the general minimum criteria for schizophrenia but do not exhibit a pattern of symptoms that is consistent with any subtype.

Schizophrenia patients may have symptoms that are part of more than one subtype. For example, Emilio appears to have both paranoid and disorganized symptoms, in that he believes his mother is trying to poison him,  he is dressed strangely, and he uses odd words and rhymes to express himself. One type of symptom, however, often trumps another.

For example,  if a patient has any disorganized symptoms, even if he has a paranoid symptom, he will receive a diagnosis of schizophrenia, disorganized type. Similarly, if a patient has any symptoms of catatonia, even if he has disorganized or paranoid symptoms, he will receive a diagnosis of schizophrenia, catatonic type.


First-Person Schizophrenia
A   leading   academic   journal   in   the   area   of   schizophrenia
research frequently publishes first-person accounts of people
suffering from schizophrenia. The following text is adapted from
one of these accounts, by Valerie Fox:

“Having suffered from schizophrenia for the past 30 years—
including a period of homelessness—I know the complexity of
the illness. When I was a young woman in my twenties,  working
for an airline and traveling throughout the world,  my life was
wonderful,  exciting.  I was part of the theater scene in New York,
liked the fabulous restaurants there,  and was thoroughly enjoy-
ing my life.

“One day,  however,  my life changed drastically.  I was diag-
nosed with schizophrenia,  hospitalized,  and given medicine.
When I was healthy enough to leave the hospital,  I was over-
whelmed.  I could not believe the medicine was good for me,
because I had never felt so depressed and lethargic as I did
while taking the medicine.  After a few months I decided to
stop taking the medicine,  believing,  as my psychiatrist did,
that I would be fine,  that I had been struggling with the transi-
tion from teenager to young womanhood,  and that my “break-
down”  would probably never recur.  This was the thinking in the
1960s. There was no talk then of body chemistry being involved
with schizophrenia.

“I did go off my medicine about six months after my first
episode.  I felt great:  I had my alertness,  my good sense of who I
was; I was not depressed; and I looked forward to working again.
Instead,  within weeks I was again hospitalized.  This time I was
sent to a long-term care facility,  a state hospital.  During this
time I decided to take charge of my life.  I realized that when I
was taking the medicine I was able to stay in the community;
without the medicine,  I was institutionalized.  I determined I
would find a way to cope with taking the medicine,  because I
did not want my life to be a revolving door from society to the
hospital and back again.

“While in remission I met a good man and discussed with my
doctor the feasibility of my getting married and having children.
I did marry and gave birth to two children.  During the course of
the marriage,  if we had an argument and I got angry,  my hus-
band would say,  “Valerie,  are you getting ill?”  I wasn’t getting
ill,  but my illness was a controlling factor for my husband to
use over me.  As this kept happening,  I knew the marriage was
over for me and that I would leave it as soon as my daughters
were a little older.  I did leave and retained custody of my two
daughters.  For 14 years,  I remained healthy and was not re-
hospitalized.  I took my medicine and went to psychotherapy.
I had gained a relative peace,  acceptance,  and a good level
of happiness.

“Then   came   a   dramatic   schizophrenic   episode.  It   started
when someone began harassing me in the middle of the night.

This harassment culminated with the person cutting my bed-
room screen.  I was terrified that because I slept so soundly
as a result of the medicine,  I would awaken one night with a
stranger in my apartment.  I decided to stop taking my medicine
against the advice of my doctor.  I had to do what I thought was
responsible,  and that was to be semi-awake in case an intruder
entered my apartment.  The police finally staked out my apart-
ment and apprehended the person who was harassing me,  but
the damage was done.  Because I was an adult and not acting
out,  I was free from forced hospitalization.  I did not know I
was ill.  My ex-husband took our children,  which I thought was
kidnapping.  No one would help me have the children returned.
I must have been visibly ill, although I was not aware of it.

“I went deeper and deeper into schizophrenia,  ending in
homelessness   for   a   two-year   period.  During   this   period   of
homelessness and mental illness,  I faced the dangers of street
living,  including being beaten and raped,  almost freezing to
death,  and being malnourished,  but I was free.  In that state,
freedom was what I wanted.  This odyssey ended one day when
I decided to do whatever it took to have the good life I had
known.  I still did not know I was ill,  but I did associate taking
medicine and being hospitalized with living as I had previously, 
before homelessness.

“One day,  I summoned every bit of strength I had and did not
back away from institutionalization.  Fortunately,  the psychiatrist
I saw during the admittance process treated me with empathy,
compassion,  and   respect.  I   trusted   him,  and,  therefore,  did
not back away from my decision to seek treatment.  I remained
hospitalized for a six-month period,  three months of which were
spent waiting for a bed in a housing program in the community.

Eventually,  I reunited with my children and built another life for
myself.  I still see a therapist and can call between visits if I am
very upset.  I don’t abuse this arrangement,  and it has served me very well.”

Table 1.4 DSM-IV diagnostic criteria for schizophrenia.
Characteristic symptoms
At least one of:
  Bizarre delusions
  Third person auditory hallucinations
  Running commentary

or two or more of:
  Delusions
  Hallucinations
  Disorganized speech
  Grossly disorganized behaviour
  Negative symptoms

Duration
1 month of characteristic symptoms
With 6 months of social/occupational dysfunction

Exclusion criteria
Schizoaffective or mood disorders
Direct consequence of substance use or general medical condition
Pervasive developmental disorders

Diagnosis of postpsychotic depression requires a clear diagnosis of schizophrenia within the past 12 months with the presence of some features of schizophrenia and predominant depressive symptoms, which meet a threshold of depressive episode, for 2 weeks.

In addition to a categorical description of schizophrenia subtypes, DSM-IV offers a dimensional alternative in its Appendix B:

  • psychotic dimension;
  • disorganized dimension; and
  •   negative dimension.

ICD-10 does not give a description of any dimensions yet as these are difficult to define.

Heather Barnett Veague, Ph.D.
Heather Barnett Veague attended the University of California, Los Angeles, and received her Ph.D. in psychology from Harvard University in 2004. She is the author of several journal articles investigating information processing and the self in borderline personality disorder. Currently, she is the Director of Clinical Research for the Laboratory of Adolescent Sciences at Vassar College. Dr. Veague lives in Stockbridge, Massachusetts, with her husband and children.

References

  1. National Alliance on Mental Illness, "About Mental Illness." Available online. URL: http://www.nami.org/template.cfm?section=By_Illness. Accessed February 22, 2007.
  2. American Experience, "People and Events: Recovery from Schizophrenia." Available online. URL: http://www.pbs.org/wgbh/amex/nash/ peopleevents/e_recovery.html. Accessed February 22, 2007.
  3. John F. Nash Jr., "Autobiography." Availalable online. URL: http://nobelprize.org/economics/ laureates/1994/nash-autobio.html. Accessed May 10, 2007.
  4. Sylvia Nasar, A Beautiful Mind. New York: Simon and Schuster, 1998, 335.
  5. American Experience,"Transcript." Available online. URL: http://www.pbs.org/wgbh/amex/nash/filmmore/pt.html. Accessed February 22, 2007.
  6. See note 2.
  7. Robert L. Spitzer et al., eds., DSM-IV-TR Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders. 4th ed., Text Revision. (Washington, DC: American Psychiatric Publishing, 2004), 189 - 90.
  8. H. Hafner et al., "The Influence of Age and Sex on the Onset and Early Course of Schizophrenia." British Journal of Psychiatry 162 (1993): 80 - 86.
  9. E. Fuller Torrey, Surviving Schizophrenia: A Manual for Families, Consumers and Providers, 3rd ed. New York: Harper Perennial, 1995, p. 79.
  10. G.A. Fava and R. Kellner, "Prodromal Symptoms in Affective Disorders." American Journal of Psychiatry 148 (1991): 828 - 830.
  11. British Columbia Schizophrenia Society, "Basic Facts about Schizophrenia," Available online. URL: http://www.mentalhealth.com/book/ p40-sc02.html#Head_4. Downloaded on November 13, 2006.
  12. Quoted in J.N. Butcher, S. Mineka, and J.M. Hooley, Abnormal Psychology. Pearson: Boston, 2004.
  13. Harrison et al., "Recovery from Psychotic Illness: A 15- and 25-year International Follow-up Study." British Journal of Psychiatry 178 (2001): 506 - 517.
  14. N.C. Andreasen, "The Role of the Thalamus in Schizophrenia." Canadian Journal of Psychiatry 42 (1997): 27 - 33.
  15. J. Hooley and S. Candela, "Interpersonal Functioning in Schizophrenia." In Oxford Textbook of Psychopathology, edited by T. Million, P.H. Blaney, and R.D. Davis. New York: Oxford University Press, 1999.
  16. J.D. Hegarty et al., "One Hundred Years of Schizophrenia: A Meta Analysis of the Outcome Literature." American Journal of Psychiatry 151, no. 10 (1994): 1409 - 1416.
  17. E.Q. Wu et al., "The Economic Burden of Schizophrenia in the United States in 2002." Journal of Clinical Psychiatry 66, no. 9 (2005): 1122 - 1129.
  18. C. Wallace, P.E. Mullen, and P. Burgess, "Criminal Offending in Schizophrenia over a 25-year Period Marked by Deinstitutionalization and Increasing Prevalence of Comorbid Substance Use Disorders." American Journal of Psychiatry, 161 (2004): 716 - 727.
  19. Suicide and Mental Health Association International, "NARSAD Publishes Top 10 Myths About Mental Illness Based on Nationwide Survey." Available online. URL: http://suicideandmentalhealth associationinternational.org/factsmythsment.html. Accessed February 22, 2007.

Provided by ArmMed Media

Email this to a friend Bookmark this! Printable Version

RELATED STORIES:


 Comments [ + Post Your Own

Now you're in the public comment zone. What follows is not Armenian Medical Network's stuff; it comes from other people and we don't vouch for it. A reminder: By using this Web site you agree to accept our Terms of Service. Click here to read the Rules of Engagement.


Flip your current gucci in to a full-blown Goldmine
top quality outlet gucci bi fold wallet with interlocking g ornament 181674 a0v1n 2019 fill you cart with savings http://movementimprovement.com.hk/wp-content/gucci-store-soho/fxgebumg-p-215.html

posted by top quality outlet gucci bi fold wallet with inter on 09/29/2014 at 5:00 am -08:00


The ultimate formula for babyliss for you to discover more about right now.
buy best karen millen dp208 draped satin red dress on sales http://webdevfoundations.net/color/herve-leger-made-in-china/karen-millen-colourful-crepe-dress-dr120-p-6592.html

posted by buy best karen millen dp208 draped satin red dress on 09/29/2014 at 6:36 am -08:00


Among The Most Complete MONCLER Guidebook You Ever Seen Otherwise Your Cash Back
buy authentic 2013 new! moncler womens down jackets stand collar slim black off 60% http://www.nuwayindustries.com/cmx/moncler-jackets-women-sale/moncler-womens-coats/2013-new-moncler-womens-down-jackets-stand-collar-slim-black-p-8543.html

posted by buy authentic 2013 new! moncler womens down jacket on 09/29/2014 at 11:22 am -08:00


Insights on how nfl jersey Made Me Rich And Famous
designer luxurious matthew stafford navy red white jersey throwback lions elite limited save now http://www.clinicaneveria.cl/css/mlb-batting-practice-jerseys/matthew-stafford-navy-red-white-jersey-throwback-lions-elite-limited-p-6303.html

posted by designer luxurious matthew stafford navy red white on 09/29/2014 at 2:54 pm -08:00


babyliss was too simple in the past, however now its close to impossible
buy burberry large nova check id wallet 34635790 brown under discount http://www.eaglespepband.com/images/burberry-watches-for-men/burberry-large-nova-check-id-wallet-34635790-brown-p-1022.html

posted by buy burberry large nova check id wallet 34635790 b on 09/29/2014 at 7:53 pm -08:00


Actual Easy Methods To Get educated about nfl jersey And How You Can Become a part of The nfl jersey Elite
wholesale cheap cheap nike texans authentic j.j. watt blue navy white jerseys free shipping outlet shop http://ckprod.com/contact/recommended-custom-made-ice-hockey-jerseys/cheap-nike-texans-authentic-jj-watt-blue-navy-white-jerseys-free-shipping-p-6601.html

posted by wholesale cheap cheap nike texans authentic j.j. w on 09/29/2014 at 8:17 pm -08:00


A perfect technique for babyliss that you can understand about this afternoon.
buy cheap onitsuka tiger olympos shoes beige black white outlet online sale http://www.beasleylawgroup.com/images/asics-canada/onitsuka-tiger-olympos-shoes-beige-black-white-p-5376.html

posted by buy cheap onitsuka tiger olympos shoes beige black on 09/29/2014 at 10:52 pm -08:00


http://www.karatechcnc.com/?keyword=Ray-Ban-Active-Lifestyle-sunglasses-for-cheap&id=6008Ray Ban Active Lifestyle sunglasses for cheap
replica lv purses outlet stores online shopping http://www.karatechcnc.com/?keyword=replica-lv-purses-outlet-stores-online-shopping&id=3540

posted by replica lv purses outlet stores online shopping on 09/29/2014 at 11:49 pm -08:00


http://www.karatechcnc.com/?keyword=Ray-Ban-Cats-Eyeglasses&id=2280Ray Ban Cats Eyeglasses
Air Jordan I Retro youth http://www.karatechcnc.com/?keyword=Air-Jordan-I-Retro-youth&id=4545

posted by Air Jordan I Retro youth on 09/30/2014 at 12:26 am -08:00


http://www.karatechcnc.com/?keyword=womens-Ray-Ban-Tech-sunglasses&id=2341womens Ray Ban Tech sunglasses
cheap Air Jordan Spizike http://www.karatechcnc.com/?keyword=cheap-Air-Jordan-Spizike&id=1312

posted by cheap Air Jordan Spizike on 09/30/2014 at 1:00 am -08:00


http://www.karatechcnc.com/?keyword=Louis-Vuitton-Insolite-Wallet-M60390&id=124Louis Vuitton Insolite Wallet M60390
ray ban balorama brown http://www.karatechcnc.com/?keyword=ray-ban-balorama-brown&id=7362

posted by ray ban balorama brown on 09/30/2014 at 1:13 am -08:00


http://www.karatechcnc.com/?keyword=Ray-Ban-Tech-sunglasses-online&id=2101Ray Ban Tech sunglasses online
lv M5923J http://www.karatechcnc.com/?keyword=lv-M5923J&id=2780

posted by lv M5923J on 09/30/2014 at 1:14 am -08:00


http://www.karatechcnc.com/?keyword=Ray-Ban-Wayfarer-Color-Mix-for-sale&id=6285Ray Ban Wayfarer Color Mix for sale
Ray Ban Wayfarer prescription http://www.karatechcnc.com/?keyword=Ray-Ban-Wayfarer-prescription&id=1820

posted by Ray Ban Wayfarer prescription on 09/30/2014 at 1:30 am -08:00


http://www.karatechcnc.com/?keyword=Air-Jordan-23-for-cheap&id=1046Air Jordan 23 for cheap
cheap air jordan 3 88 release date http://www.karatechcnc.com/?keyword=cheap-air-jordan-3-88-release-date&id=5203

posted by cheap air jordan 3 88 release date on 09/30/2014 at 1:34 am -08:00


http://www.karatechcnc.com/?keyword=Ray-Ban-Active-Lifestyle-Solid-knockoffs&id=2335Ray Ban Active Lifestyle Solid knockoffs
lv Damier Azur Boogie Sneaker In Damier Azur Canvas XR4U2PDA http://www.karatechcnc.com/?keyword=lv-Damier-Azur-Boogie-Sneaker-In-Damier-Azur-Canvas-XR4U2PDA&id=3137

posted by lv Damier Azur Boogie Sneaker In Damier Azur Canva on 09/30/2014 at 1:42 am -08:00


http://www.karatechcnc.com/?keyword=fake-ray-ban-tortuga-sunglasses&id=7332fake ray ban tortuga sunglasses
Ray Ban Cats 1000 sunglasses for sale http://www.karatechcnc.com/?keyword=Ray-Ban-Cats-1000-sunglasses-for-sale&id=2202

posted by Ray Ban Cats 1000 sunglasses for sale on 09/30/2014 at 1:56 am -08:00


http://www.karatechcnc.com/?keyword=Ray-Ban-Cats-knockoffs&id=6027Ray Ban Cats knockoffs
Air Jordan 12 Playoffs 2012 for sale http://www.karatechcnc.com/?keyword=Air-Jordan-12-Playoffs-2012-for-sale&id=1591

posted by Air Jordan 12 Playoffs 2012 for sale on 09/30/2014 at 2:04 am -08:00


http://www.karatechcnc.com/?keyword=replica-ray-ban-outlet-california&id=6790replica ray ban outlet california
nike Air Jordan 11 Low Concord http://www.karatechcnc.com/?keyword=nike-Air-Jordan-11-Low-Concord&id=960

posted by nike Air Jordan 11 Low Concord on 09/30/2014 at 2:08 am -08:00


Independent statement divulges Unique great new things regarding babyliss that no one is speaking of.
the cheapest hermes birkin bag 30 etoupe taupe grey clemence leather gold har supper summer savings http://www.dhruvts.com/books/hermes-evelyne-bag-sizes/hermes-birkin-bag-30-etoupe-taupe-grey-clemence-leather-gold-har-p-4538.html

posted by the cheapest hermes birkin bag 30 etoupe taupe gre on 09/30/2014 at 2:14 am -08:00


http://www.karatechcnc.com/?keyword=Ray-Ban-Clubmaster-Color-Mix-discount&id=5862Ray Ban Clubmaster Color Mix discount
Air Jordan IX on sale http://www.karatechcnc.com/?keyword=Air-Jordan-IX-on-sale&id=1303

posted by Air Jordan IX on sale on 09/30/2014 at 2:22 am -08:00

   1 2 3 >  Last » Page 1 of 5 pages



We are pleased to let readers post comments about an article. Please increase the credibility of your post by including your full name and email.

All comments are reviewed by our editors before they are posted on the site. Just keep it clean, kids.

Name:

Email:

Location:

URL:

Remember my personal information

Notify me of follow-up comments?

   [advanced search]   
Interactive Quiz:
I have a decreased need for sleep.
yes
no
Test you knowledge



Health Centers

Health Centers





Diabetes









Health news
  


Health Encyclopedia

Diseases & Conditions

Drugs & Medications

Health Tools

Health Tools



   Health newsletter

  





   Medical Links



   RSS/XML News Feed



   Feedback






Add to Google Reader or Homepage
Mental Health News, Headlines and Latest Stories on Health.am
Add to My AOL





UrologyToday.net
Popular Searches:
» depressed what to do?
» helping the depressed person
» depression glossary
» adolescent depression
» major depression
» types of depression
» checklist for depression
» depression overview
» symptoms of depression
» what Is depression?