Simple schizophrenia: symptoms, causes and treatment

This clinical category associated with psychoticism appears in the ICD-10 diagnostic manuals.

Mental disorders are the subject of study in clinical psychology. One of the most disabling is schizophrenia, a chronic and severe disorder whose lifetime prevalence is between 0.7 and 1.5%.

Within this concept, several subtypes have been proposed. In this article we will discuss one of them, simple schizophrenia.. This diagnosis has caused some controversy as to whether or not to include it as an independent diagnosis in the different reference mental health manuals (DSM, ICD,...).

At present it only exists as a diagnostic category in ICD-10, as we will see below. This controversy has arisen due to the questioning of the descriptive validity and reliability of the concept, as well as its infrequent use.

Symptoms of schizophrenia.

To know the simple schizophrenia before we are going to see the three most characteristic types of symptoms in schizophrenia, which are the following.

Positive

Appearance or exacerbation of some psychological function.. For example, hallucinations, delusions, disorganized language and disorganized behavior.

These are typically known as psychotic behaviors. The patient may "lose touch" with reality.

Negatives

Absence or reduction of some function, for example affective flattening, decreased fluency and thinking, apathy, apathy, abulia, reduced speech, etc.apathy, apathy, abulia, reduction of speech, etc. Thus, they are associated with the interruption of behavior and emotions considered normal.

It is important to make a differential diagnosis with depression or other mood problems.

Cognitive

Reduction or impairment of some cognitive processes such as attention, memory and executive functions (working memory, speed of thinking,...). (working memory, speed of thought,...).

Thus, the patient may show difficulties in attention and concentration, difficulty in understanding information and making decisions, etc. Lack of awareness of the disease (anosognosia) may also appear.

What characterizes simple schizophrenia?

Simple schizophrenia is a classic category that remains only in ICD-10 (WHO International Classification of Diseases). ICD-6 included it for the first time in 1948, as did DSM-I in 1952.

The DSM-III eliminated this subtype, and the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders) includes it under Criteria and proposed axes for further study, with the name of simple deteriorating disorderconsidering it a disorder that requires further studies for its possible inclusion. In the DSM-5, however, it does not appear.

Its characteristics consist of an insidious and progressive onset of extravagant behavior, a decrease in general performance and an inability to meet social demands. There is no evidence, at any time, of the presence of hallucinations or delusions..

That is, the symptoms are only negative, with no psychotic episode appearing at any time, which is the element that would make the difference with the residual type (in which there has been a psychotic episode, but at the time of diagnosis there are no positive symptoms, but continuous manifestations in the form of negative symptoms).

Symptoms involve alterations in personal relationships, as well as a significant worsening of work or academic activity. Fleeting episodes of self-referential delirium, depressive mood and social isolation may be associated.

It is necessary that the symptoms are present during a period of at least 1 year of duration. Its prognosis is very poorIn fact, it is the subtype of schizophrenia with the worst prognosis, together with hebephrenic or disorganized schizophrenia.

Origin of the term: Eugen Bleuler

Simple schizophrenia was proposed by Eugen Bleuler. This author proposed five clinical forms of schizophrenia. Three of them coincided with Kraepelin's subtypes: paranoid, catatonic and hebephrenic. The last one was a "latent" schizophrenia, compensated or paucisymptomatic.

Bleuler introduced the term "schizophrenia" (split mind) and characterized the condition on the basis of its most important psychopathological feature, which was the splitting of the self. Thus, unlike Kraepelin, he focused on the nuclear psychopathology, and not so much on the symptomatology.and not so much on symptomatology and evolution.

This author distinguished essential symptoms (fundamental and common to all schizophrenic disorders) from accessory symptoms (more striking but less important).

Differential diagnosis with residual schizophrenia

The differential diagnosis will be made with other subtypes of schizophrenia, as well as with other affective disorders, personality disorders, organic mental disorders, etc. However, we are going to focus on residual schizophrenia, since it can make us doubt the diagnosis, due to its similarity.

As we have seen above, residual schizophrenia is characterized by negative symptoms and attenuated positive symptoms. Significant positive symptoms may have appeared in the past, but at the time of examination the patient has only negative symptoms. In simple schizophrenia, on the other hand, there have never been positive symptoms..

Treatment

The treatment of simple schizophrenia consists of an interdisciplinary approach between physicians and clinical psychologists. It is usually based on psychotherapy and the use of psychotropic drugs for support.

• For more details on the intervention in these cases, see this article: What is schizophrenia? Symptoms and treatments"

Bibliographical references:

• Jiménez, M., Ramos, F., Sanchís, M. Schizophrenias: Clinical aspects. In Belloch, A., Sandín, B., Ramos, F. (1996). Manual de psicopatologóa. McGraw-Hill, Madrid.
• Novella, E. and Huertas, R. (2010). Kraepelin-Bleuler-Schneider Syndrome and Modern Consciousness: an approach to the history of schizophrenia. Clinical and Health, 21(3), 205-219.
• National Institute of Mental Health (2015). Schizophrenia.