Schizophrenia Types | Subtypes of Schizophrenia
Schizophrenia Types and Subtypes:
Schizophrenia can be classified into the following subtypes:
2. Hebephrenic (disorganized)
7. Post- schizophrenic depression
The word ‘paranoid’ means ‘delusional’. Paranoid schizophrenia is at present the most common form of schizophrenia. It is characterized by the following features (in addition to the general features already described).
- Delusions of persecution: In persecutory delusions, individuals believe that they are being malevolently treated in some way.
Frequent themes include being conspired against, cheated, spied upon, followed, poisoned or drugged, maliciously maligned, harassed or obstructed in the pursuit of long-term goals.
- Delusions of jealousy: The content of jealous delusions centres around the theme that the person’s sexual partner is unfaithful. The idea is held on inadequate grounds and is unaffected by rational judgment.
- Delusions of grandiosity: Individuals with grandiose delusions have irrational ideas regarding their own worth, talent, knowledge or power. They may believe that they have a special relationship with famous persons, or grandiose delusions of a religious nature may lead to assumption of the identity of a great religious leader.
· Hallucinatory voices that threaten or command the patient, or auditory hallucinations without verbal form, such as whistling, humming and laughing.
· Other features include disturbance of affect (though affective blunting is less than in other forms of schizophrenia), volition, speech and motor behaviour.
Paranoid schizophrenia has a good prognosis if treated early. Personality deterioration is minimal and most of these patients are productive and can lead a normal life.
Hebephrenic (disorganized) Schizophrenia
It has an early and insidious onset and is often associated with poor premorbid personality. The essential features include marked thought disorder, incoherence, severe loosening of associations and extreme social impairment. Delusions and hallucinations are fragmentary and changeable.
Other oddities of behavior include senseless giggling, mirror-gazing, grimacing, mannerisms and so on. The course is chronic and progressively downhill without significant remissions. Recovery classically never occurs and it has one of the worst prognoses among all the sub types.
Catatonic (Cata (i.e.) disturbed) schizophrenia is characterized by marked disturbance of motor behaviour. This may take the form of catatonic stupor, catatonic excitement and catatonia alternating between excitement and Clinical features of excited catatonia:
· Increase in psychomotor activity (ranging from restlessness, agitation, excitement, aggressiveness to at times violent behaviour).
· Increase in speech production.
· Loosening of associations and frank incoherence.
Sometimes excitement becomes very severe and is accompanied by rigidity, hyperthermia and dehydration and can result in death. It is then known as acute lethal catatonia or pernicious catatonia.
Clinical features of retarded catatonia (catatonic stupor):
· Mutism: Absence of speech.
· Rigidity: Maintenance of rigid posture against efforts to be moved.
· Negativism: A motiveless resistance to all commands and attempts to be moved, or doing just the opposite.
· Posturing: Voluntary assumption of an inappropriate and often bizarre posture for long periods of time.
· Stupor: Does not react to his surroundings and appears to be unaware of them.
· Echolalia: Repetition or mimicking of phrases or words heard.
· Echopraxia: Repetition or mimicking of actions observed.
· Waxy flexibility: Parts of body can be placed in positions that will be maintained for long periods of time, even if very uncomfortable (flexible like wax).
· Ambitendency: A conflict to do or not to do, e.g. on asking to put out tongue, it is slightly protruded but taken back again.
· Automatic obedience: Obeys every command though he has first been told not to do so.
Symptoms of residual schizophrenia include emotional blunting, eccentric behaviour, illogical thinking, social withdrawal and loosening of associations. This category should be used when there has been at least one episode of schizophrenia in the past but without prominent psychotic symptoms at present.
This category is diagnosed either when features of no subtype are fully present or features of more than one subtype are exhibited.
It is characterized by an early and insidious onset, progressive course, presence of characteristic negative symptoms, vague hypochondriacal features, wandering tendency, self-absorbed idleness and aimless activity. It differs from residual schizophrenia in that there never has been an episode with all the typical psychotic symptoms. The prognosis is very poor.
Depressive features develop in the presence of residual or active features of schizophrenia and are associated with an increased risk of suicide.