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Subtypes of Schizophrenia

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Subtypes of Schizophrenia

Categorizing symptoms of a disorder can be an effective way to understand the disorder. While schizophrenia has been a heavily researched disorder, psychologists still have a lot of questions about the complex disorder. While the application of the subtypes of schizophrenia has evolved in the field of psychology, they remain a useful tool in understanding and treating schizophrenia.

  • We'll begin this article by exploring how the classic subtypes of schizophrenia disorder were created.
  • After this, we'll discuss common subtypes of schizophrenia.
  • We will then take a moment to understand undifferentiated schizophrenia.
  • Then, we will go into detail about catatonic schizophrenia and residual schizophrenia.

Classic Subtypes of Schizophrenia Disorder

There are five classic subtypes of schizophrenia disorder: paranoid schizophrenia, disorganized (hebephrenic) schizophrenia, undifferentiated schizophrenia, residual schizophrenia, and catatonic schizophrenia. The nosology of schizophrenia into subtypes can be credited to two psychiatrists: Emil Kraepelin and Eugen Bleuler.

Nosology is the scientific classification and study of disorders or diseases.

Emil Kraepelin was a German psychiatrist who spent time working with the well-known psychologist Wilhelm Wundt and was the first to make the distinction between dementia praecox and manic depression.

Dementia praecox is an early term for schizophrenia that was thought to be an early onset of a neurodegenerative disease.

Swiss-born psychiatrist Eugen Bleuler is responsible for changing the name to schizophrenia because he thought the disorder is better characterized by "split" psychic functions. The five classic subtypes of schizophrenia were born out of the ways in which Bleuler and Kraepelin classified symptoms of schizophrenia.

This remained the common method of classifying and diagnosing schizophrenia in the Diagnostic and Statistical Manual (DSM) until the DSM-5. This decision was made because the subtypes were believed to have low validity and reliability for diagnosis. However, the five subtypes of schizophrenia are still useful for understanding an individual's experience with schizophrenia and creating a treatment plan tailored for each person.

Subtypes of Schizophrenia Disorder

Let's begin by defining two of the most common subtypes of schizophrenia -- paranoid and disorganized schizophrenia.

Paranoid Schizophrenia

Paranoid schizophrenia is the most common type of schizophrenia and is characterized by delusions of persecution or delusions of grandeur.

Delusions of persecution are delusions in which a person believes that others are out to harm them.

Delusions of grandeur are delusions in which a person believes they are an incredibly important or powerful person.

Maybe they believe they're being hunted by secret spies (delusions of persecution) or that they could defy gravity because they believe they are God (delusions of grandeur).

Subtypes of Schizophrenia, shadow of hand with knife behind paranoid man, StudySmarterDelusions of persecution, Freepik.com

These beliefs are clearly abnormal and most of us would be concerned about them. However, people who could be diagnosed with paranoid schizophrenia are often still capable of caring for themselves and all other cognitive and emotional functioning are likely intact.

For this reason, recognizing symptoms of paranoid schizophrenia can be difficult to do unless the patient is talking about the topic of their delusion. While paranoid schizophrenia has the highest recovery rate, it is also most commonly associated with aggressive behavior. It is also known to have the highest suicide rate of all schizophrenia subtypes.

Disorganized (Hebephrenic) Schizophrenia

Disorganized schizophrenia (also called hebephrenic schizophrenia) is characterized by disordered speech and behavior as well as inappropriate emotional responses. People with disorganized schizophrenia may have childlike behavior like giggling or silliness. They may also dress strangely, use obscene talk or speak incoherently. It can be very difficult to communicate with someone with disorganized schizophrenia.

Another feature of this subtype of schizophrenia is that their emotional responses often do not match the moment.

Someone with disorganized schizophrenia may laugh at violent events reported on the news.

The onset of disorganized schizophrenia symptoms can occur gradually which could make it difficult to spot at first. It might be dismissed as simply a reaction to adjusting to adult life as the onset of schizophrenia for men is late teens to early 20s and for women, late 20s to early 30s. Treatment for disorganized schizophrenia usually includes a combination of medication and psychotherapy such as cognitive-behavioral therapy.

People with disorganized schizophrenia may be unable to function by themselves. For this reason, treatment might also include skills training to help people with this subtype of schizophrenia find and keep a job. Also, ensuring the person has support from family or loved ones can also be especially beneficial in treating disorganized schizophrenia.

Undifferentiated Schizophrenia

When the subtypes were used to diagnose schizophrenia, there would be times when someone didn't quite fit all the criteria for any one subtype. In this case, they were diagnosed with undifferentiated schizophrenia.

Undifferentiated schizophrenia was a term used to diagnose people who did not specifically match the criteria for disorganized, paranoid, catatonic, or residual schizophrenia.

People who were diagnosed with undifferentiated schizophrenia still experienced psychiatric symptoms (delusions and hallucinations) but often had symptoms of more than one subtype of schizophrenia. Undifferentiated schizophrenia can also be characterized by:

  • a reduction in relationships and interests

  • a lack of emotional depth

  • thinking becomes more simple and concrete

Catatonic Schizophrenia

One of the most severe subtypes of schizophrenia is catatonic schizophrenia. Catatonic schizophrenia is characterized by noticeable motor disturbances such as muscle rigidity or random and repetitive movements.

People with catatonic schizophrenia are unable to effectively care for themselves and likely require constant care. They usually alternate between a stuporous state and agitated excitement. During the stuporous state, they may seem unaware of reality or experience a symptom called wavy flexibility.

Wavy flexibility is a catatonic symptom in which a person's limbs can be molded by another person, in even the most grotesque positions, and maintained for hours.

Other characteristics of catatonic schizophrenia include:

  • Jerking movements

  • Frozen facial expressions

  • Mute

  • Involuntarily speech

  • Senseless repetition of words or phrases said by others

  • Slowed movements

  • Opposite response to requestions to move

  • Mimic other people's motions

There are several theories used to explain the etiology of catatonic schizophrenia. One suggests that it is due to a disruption in GABAergic (gamma-aminobutyric acid) neurotransmitters which are responsible for regulating emotional and cognitive functions. It's also important for clinicians to rule out any potential influence from antipsychotic medication as catatonic symptoms can be a side effect.

People with catatonic schizophrenia often have a poor prognosis. It is key to begin treating catatonic schizophrenia as early as possible. Electroconvulsive therapy (ECT) is usually the treatment of choice for catatonic schizophrenia although many may relapse within a year. Benzodiazepines may also be used first, although ECT is shown to be the most effective.

Subtypes of Schizophrenia, man sitting in chair depressed, StudySmarterNegative symptoms can resemble depression, Freepik.com

Residual Schizophrenia

Schizophrenia symptoms can be in one of two categories -- positive or negative symptoms. Positive symptoms include symptoms are any changes to thoughts or behavior like hallucinations or delusions. Negative symptoms might include flattened affect, alogia (poor speech), or anhedonia (inability to feel pleasure).

At some point, or during treatment, a person's symptoms may begin to subside.

Residual schizophrenia is used to describe people with schizophrenia whose positive symptoms have subsided but their negative symptoms remain.

Regardless of the subtype, anyone with schizophrenia can develop residual schizophrenia. Residual schizophrenia can be characterized by:

  • Emotional withdraw
  • Lack of judgment and insight
  • Difficulty with abstract thinking
  • Poor attention
  • Anxiety
  • Social withdraw
  • Bluntness

Clinicians should also be careful in distinguishing symptoms of residual schizophrenia from potential symptoms of depression as they can look very similar. Distinguishing symptoms of depression include sleep disturbances, depressed mood, or loss of appetite.

When subtypes were used to diagnose schizophrenia, a residual schizophrenia diagnosis was meant to be temporary. At some point either the person's positive symptoms relapsed or their negative symptoms began to subside as well. Some medications used to treat schizophrenia may be designed to primarily reduce positive symptoms, leaving negative symptoms untreated and leaving someone with residual schizophrenia. Psychotherapy and psychosocial interventions have proven effective in reducing negative symptoms and are therefore the treatment of choice for residual schizophrenia.

Subtype of Schizophrenia - Key takeaways

  • Swiss-born psychiatrist Eugen Bleuler is responsible for changing the name to schizophrenia because he thought the disorder is better characterized by "split" psychic functions. The five classic subtypes of schizophrenia were born out of how Bleuler and Emil Kraepelin classified symptoms of schizophrenia.
  • Paranoid schizophrenia is the most common type of schizophrenia and is characterized by delusions of persecution or delusions of grandeur.
  • Undifferentiated schizophrenia was a term used to diagnose people who did not specifically match the criteria for disorganized, paranoid, catatonic, or residual schizophrenia.
  • One of the most severe subtypes of schizophrenia is catatonic schizophrenia. Catatonic schizophrenia is characterized by noticeable motor disturbances such as muscle rigidity or random and repetitive movements.
  • Residual schizophrenia is used to describe people with schizophrenia whose positive symptoms have subsided but their negative symptoms remain.

References

  1. Jain A, Mitra P. Catatonic Schizophrenia. [Updated 2021 Nov 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563222/
  2. Suzuki K, Awata S, Matsuoka H. One-year outcome after response to ECT in middle-aged and elderly patients with intractable catatonic schizophrenia. J ECT. 2004 Jun;20(2):99-106.

Frequently Asked Questions about Subtypes of Schizophrenia

The 5 subtypes of schizophrenia listed in the DSM-IV were paranoid, catatonic, undifferentiated, disorganized, and residual. However, the most updated DSM-V does not include these 5 subtypes. 

There were 5 separate subtypes of schizophrenia listed in the DSM-IV. 

One of the most severe subtypes of schizophrenia is catatonic schizophrenia. Catatonic schizophrenia is characterized by noticeable motor disturbances such as muscle rigidity or random and repetitive movements. People with catatonic schizophrenia are unable to effectively care for themselves and likely require constant care.

Residual schizophrenia is used to describe people with schizophrenia whose positive symptoms have subsided but their negative symptoms remain.

Disorganized and catatonic schizophrenia has the poorest prognosis.

Final Subtypes of Schizophrenia Quiz

Question

What are the 5 subtypes of schizophrenia?

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Answer

  • Paranoid
  • Catatonic
  • Undifferentiated
  • Disorganized
  • Residual

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Question

How many subtypes of schizophrenia are there?

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Answer

There are 5 separate subtypes.

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The international prevalence of schizophrenia is around ___%

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1

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The average age of onset of schizophrenia is ___ in men and ____ in women. 

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Answer

18; 25

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What are the three main criteria (Criterion A) for the diagnosis of schizophrenia?

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Answer

1. Hallucinations

2. Delusions

3. Disorganized speech, or disorganized actions 

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The DSM V (Does? / Does NOT?) include the 5 subtypes of schizophrenia.

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Answer

Does NOT

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There (is? / is NOT?) a single genetic mutation that is associated with the development of schizophrenia?

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Answer

is NOT

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The paranoid schizophrenia subtype is primarily defined as?

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Patients are preoccupied with their delusion or hallucination which is normally persecutory in nature. 

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A bizarre delusion is?

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A delusion that is not theoretically possible (aliens chasing the patient) 

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A non-bizarre delusion is?

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A delusion that is theoretically possible (the neighbor is trying to poison the patient)

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The disorganized subtype of schizophrenia requires the patient to primarily have? 

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Answer

Disorganized speech, behavior, or flat affect.

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What is flat affect? 

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Flat affect is an inappropriate response to emotional situations. The patient has no response when they should be smiling or frowning. 

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The criteria for the catatonic subtype of schizophrenia (Does? / Does NOT?) include mutism. 

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Does

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Criterion B of schizophrenia highlights? 

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Answer

A loss in the patient's functional status. 

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The residual subtype of schizophrenia (has? / Does NOT have?) overt psychotic symptoms.

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Answer

Does NOT

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Question

What is nosology?

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Answer

The scientific classification and study of disorders or diseases

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Question

What is dementia praecox?

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Answer

An early term for schizophrenia that was thought to be an early onset of a neurodegenerative disease

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Question

What are delusions of persecution?

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Answer

Delusions in which a person believes that others are out to harm them

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What are delusions of grandeur?

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Answer

Delusions in which a person believes they are an incredibly important or powerful person

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Which subtype of schizophrenia has the highest recovery rate?

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Answer

Paranoid schizophrenia

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Which subtype of schizophrenia has the highest rates of suicide?

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Answer

Paranoid schizophrenia

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Question

In which subtype of schizophrenia does the person have emotional responses that don't match the moment?

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Answer

Residual schizophrenia

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Question

Why did undifferentiated schizophrenia become a diagnosis?

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Answer

There were people with schizophrenia who did not fit the specific criteria for the other subtypes (or could have symptoms from multiple different subtypes at once)

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In which subtype of schizophrenia does the person have symptoms of multiple subtypes of schizophrenia?

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Answer

Disorganized (hebephrenic) schizophrenia

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Question

What is wavy flexibility?

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A person's limbs can be molded by another person, in even the most grotesque positions, and maintained for hours

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In which subtype of schizophrenia can the person experience wavy flexibility?


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Answer

Disorganized (hebephrenic) schizophrenia

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Which subtype of schizophrenia is extremely severe with low rates of recovery?


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Undifferentiated schizophrenia

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What treatment is best for catatonic schizophrenia?

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Answer

Electroconvulsive therapy (ECT)

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What are positive symptoms?

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Symptoms where something is added that changes thoughts or behaviors

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What are negative symptoms?

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Symptoms where something is taken away or the ability to do something is lost

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Which of these is a positive symptom?

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Hallucinations

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Which of these is a negative symptom?

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Delusions

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When can someone get diagnosed with residual schizophrenia?

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When the positive symptoms subside but there are still negative symptoms

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Which subtype(s) of schizophrenia can result in a residual diagnosis?

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All of them

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Question

Which other mental health disorder does residual schizophrenia look similar to?

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Answer

Depression

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