The 6 types of schizophrenia (causes and symptoms)

Schizophrenia is a serious psychotic disorder that affects 0.3-0.7% of the population..

It is characterized by the presence of delusions, hallucinations, disorganized behavior, and cognitive symptoms. However, there is no single disorder; there are different types of schizophrenia.

In this article we will know the 6 types of schizophrenia that we can find in the DSM-IV-TR and in the ICD-10.based on their differentiated symptomatology. On the other hand, we will also talk about 2 other types of schizophrenia, according to the classification made by Timothy Crow in 1980: type I schizophrenia and type II schizophrenia.

Schizophrenia: definition and characteristics

Schizophrenia is a type of serious mental disorder, specifically a psychotic disorder.. The overall vital prevalence of schizophrenia is 0.3-0.7% in the population; however, in first-degree relatives of schizophrenic patients, it rises to 10%. This is why there is talk of an important genetic factor in its aetiology.

This disorder occurs more frequently in urban than in rural settings. On the other hand, migrants are known to have a higher risk of developing the disorder.

Symptoms

There are two types of symptoms of schizophrenia: positive and negative. Thus, while the former include manifestations of “excess”, the latter include symptoms of “defect”.

Positive symptoms include hallucinations, delusions, psychomotor disturbances, disorganized thought and language.among others. Negative symptoms include abulia (lack of energy), affective flattening (absence of emotional expressions) or alogia (impoverishment of language).

As we will see later in this article, there is a classification that differentiates two types of schizophrenia, depending on whether it has positive or negative symptoms.

Types of schizophrenia

On the other hand, although schizophrenia, like any disorder, manifests itself in different ways in each person, it also it is true that there are different types of schizophrenia, depending on their symptoms.

This classification is found in the ICD-10 (International Classification of Diseases) and in the DSM-IV-TR (Diagnostic Manual of Mental Disorders); in the DSM-5, but the types of schizophrenia are suppressed.

Let’s see what they are:

1. Paranoid schizophrenia

The first of the schizophrenia types, the paranoid, is characterized by the presence of positive symptoms such as hallucinations or delusions (which can also be delusional ideas). Other areas, such as language, behaviour or affectivity, tend to be better preserved.

Hallucinations are usually auditory. As for delusions, they are usually well organized in relation to a central theme; generally, these are persecutory, referential, prejudicial or great content. In addition, the hallucinations mentioned above are often related to the theme of delirium.

Of all the types of schizophrenia, the paranoid type is the one with the latest onset. On the other hand, the cognitive and social deterioration is less, and its prognosis is the best among the different types of schizophrenia that exist.

2. Disorganized-type schizophrenia

Disorganized schizophrenia, also called hebephrenic, has a worse prognosis than the previous one and starts earlier (in fact, of the types of schizophrenia it is the one that starts earlier). Characterized by disorganized language and behavior, and flat or inappropriate affectivity. Thus, negative symptoms are more prevalent in this type of schizophrenia.

Unlike the previous one, in it delirious ideas and hallucinations are not usually well organized; that is, they are fragmented, disorganized, and have little systematization. At the cognitive level, the affectation is greater if we compare it with the paranoid type. Subjects with paranoid schizophrenia have simple, extravagant thoughts and behaviors.

Its beginning, which is usually very early and insidious, appears after a period where the person has been socially isolated little by little, moment in which in addition, the personality has been impoverished also. Its course is continuous and without significant remissions. On a prognostic level, this one’s pretty bad.

3. Catatonic schizophrenia

The next type of schizophrenia, the catatonic, is characterized mainly by an alteration of the motor type. This alteration results in one or more of the following symptoms: immobility (with or without catalepsy), waxy flexibility, motor agitation, negativism or automatic obedience, ambivalence, mutism, echolalia and ecopraxia (repeat the interlocutor’s gestures).

This is the least common type among the different types of schizophrenia.

4. Undifferentiated type schizophrenia

This schizophrenia encompasses those cases of patients who show criteria for schizophrenia, but who do not fit into any of the above types of schizophrenia.

5. Residual type schizophrenia

Residual schizophrenia is characterized by the fact that the patient has, at some point, had some psychotic episode, but does not currently show any positive symptoms specific to the disorder (no delusions, no hallucinations…). However, there are still continuous manifestations of symptoms; in this case, negative symptoms.

6. Simple-type schizophrenia

Simple schizophrenia was first described by Eugen Bleuler, a Swiss psychiatrist. This category, unlike the previous ones, only appears in the ICD-10, and not in the DSM-IV-TR as a specific category (yes in its annex).

It is characterized by the fact that there have never been delusions or hallucinations; that is to say, there have never been positive symptoms.unlike in residual schizophrenia, where they have existed, although they do not endure at the present time.

Simple schizophrenia has an insidious and progressive onset; the first symptom to appear is extravagant behavior. On the other hand, the patient’s overall performance decreases; he is unable to meet the social demands of his day-to-day life. In order to be diagnosed, symptoms must last for at least 1 year. As for your prognosis, this is very bad.

Crow’s ranking

A second classification of types of schizophrenia is developed by psychiatrist Timothy Crowin 1980. This author differentiates two types of schizophrenia: type I and type II.

Let’s see what each of them consists of, and what differences they present.

1. Type I schizophrenia (positive)

Type I schizophrenia has positive symptoms at its coreThat is to say, hallucinations, delusions, disorders of thought and/or disorganized or strange behavior appear. Unlike type II (irreversible), in type I the forecast is reversible. On the other hand, the patient’s premorbid adjustment (period prior to the onset of the disorder) is better in this than in type II.

As for its onset, this is usually acute; the course is also acute, with outbreaks and remissions. In relation to the patient’s response to the administration of neuroleptics (antipsychotics), this is good. Finally, there is no neurological impairment in this type of schizophrenia.

2. Type II schizophrenia (negative)

The second type of schizophrenia, following the classification of T. Crow, is type II, characterized by negative symptoms (affective flattening, language poverty, motivational symptoms…). His prognosis, as we said, is worse (irreversible), and the patient’s premorbid adjustment is also worse.

It starts insidiously, unlike the previous one, and its course is chronic. As for the response of the patient administering neuroleptics, this is usually poor. Unlike type I, in type II there is some neurological deterioration at brain level.

Differences between men and women

No longer talking about the types of schizophrenia, but in relation to the differences in the presentation of the disorder between men and women, we find the following: in men, the age of onset is earlier (between 15 and 24 years) than in women (25 and 34 years)In relation to premorbid adjustment, it is worse in men than in women.

Finally, a third difference between both sexes is that in men the negative symptoms stand out, and in women, the positive and affective ones.

Bibliographical references:

• American Psychiatric Association (APA). (2002). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. Barcelona: Masson.

• American Psychiatric Association (APA) (2014). DSM-5. Diagnostic and statistical manual of mental disorders. Madrid Pan-American.

• Belloch, A., Sandín, B. and Ramos, F. (2010). Manual of Psychopathology. Volume I and II. Madrid: McGraw-Hill.

• WHO (2000). ICD-10. International Classification of Diseases, tenth edition. Madrid Pan-American.