Types of schizophrenia

Within psychiatric disorders, schizophrenia is classified in the group of psychotic disorders, in which there is a alteration of perception of reality. It is estimated that worldwide between 0.5% and 1% of the population is affected by this disease. In Spain about 400,000 people suffer from this disease, although it is estimated that there are more undiagnosed patients.

Schizophrenia is a heterogeneous disease that has classically been classified into five types: paranoid, disorganized, catatonic, undifferentiated, and residual.

Paranoid schizophrenia

It is characterized by the presence of excessive preoccupation with one or more delusions of various kinds or frequent auditory hallucinations (they hear voices). The language is normal, as well as the behavior initially; They are not reactive or show flattened affectivity.

Disorganized or hebephrenic schizophrenia

The predominant features are that both language and behavior are altered, they do not seem to have order or concert or respond to external stimuli in an adequate way. In these patients, affectivity is altered, being flattened or the reaction being inappropriate.

Catatonic schizophrenia

They are characterized by presenting immobility (called catalepsy), extreme negativism, mutism, the adoption of strange postures or stereotyped movements, as well as abundant grimaces and mannerisms or the imitation of the words or movements of the interlocutor (echolalia and echopraxia respectively). Sometimes, on the contrary, they can present excessive motor activity.

Undifferentiated schizophrenia

It is described as one in which symptoms such as those described above occur but without these being able to classify it as paranoid, disorganized or catatonic as a whole.

Residual schizophrenia

There are no delusions, hallucinations, catatonia, or disorganized language or behavior. There are only mild manifestations of both positive and negative symptoms but of lesser magnitude (strange beliefs, unusual perceptual experiences).

From a therapeutic point of view, despite this classic classification, patients with schizophrenia are usually classified into two large groups:

• Schizophrenia with a predominance of positive symptoms, includes auditory hallucinations, delusions, serious distortions of language and behavior.
• Schizophrenia with a predominance of negative symptoms, such as apathy, affective flattening, catalepsy, the lack of will to carry out any task (abulia), the inability to enjoy anything (anhedonia) or to express feelings (alexithymia) or the poverty of language (alogia).

How is it diagnosed?

Schizophrenia is diagnosed based on a number of criteria:

• Presence of delusions, hallucinations, disorganized language, disorganized behavior, catatonia, or negative symptoms (apathy, poor language, inability to enjoy)
• Social or occupational dysfunction caused by the disease
• Duration of symptoms greater than six months
• Exclusion of other psychotic disorders (schizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder or shared psychotic disorder) exclusion of organic causes or use of substances that explain the symptoms.

Causes of schizophrenia

As in many psychiatric illnesses, the factors that lead to the appearance of schizophrenia are diverse, among them:

• Genetic factors.
• Structural factors, such as the increase in the size of the cerebral lateral ventricles, the reduction in the size of certain medial structures or the reduced functioning of the frontal cerebral cortex.
• Psychosocial and family factors.

Evolution of the disease

The vast majority of schizophrenic patients are unaware of their illness and in general this disorder usually evolves in four stages:

• Prepsychotic period with symptoms that may lead to suspicion of the disorder
• First psychotic break
• Recovery stage
• Persistence of symptoms without remission despite treatment

Today, there are multiple drugs that allow treating schizophrenia in all its varieties, alleviating the symptoms but never actually curing the disorder. As in almost all psychiatric disorders, the therapeutic approach will not only be pharmacological but also through psychotherapy, both to the patient and family, and psychoeducation.

Schizophrenia is a disease that is difficult to live with, both for those who suffer from it and for those around them, so it is vital to contact a specialist if you suspect that someone close to you may suffer from it.

• In schizophrenia there is an alteration in the perception of reality.
• It has been classified into five types: paranoid, disorganized, catatonic, undifferentiated, and residual.
• As in almost all psychiatric disorders, the therapeutic approach will not only be pharmacological but also with psychotherapy, the patient and family, and psychoeducation.