The latest edition of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (APA, 2013) no longer categorizes schizophrenia according to the below sub-types, disorganized schizophrenia and residual schizophrenia. However, many clinicians and psychiatrists still refer to these sub-types and use them in their diagnostic process. They are listed here for historical and information purposes.
As the name implies, this subtype’s predominant feature is disorganization of the thought processes. As a rule, hallucinations and delusions are less pronounced, although there may be some evidence of these symptoms. These people may have significant impairments in their ability to maintain the activities of daily living. Even the more routine tasks, such as dressing, bathing or brushing teeth, can be significantly impaired or lost.
Often, there is impairment in the emotional processes of the individual. For example, these people may appear emotionally unstable, or their emotions may not seem appropriate to the context of the situation. They may fail to show ordinary emotional responses in situations that evoke such responses in healthy people. Mental health professionals refer to this particular symptom as blunted or flat affect. Additionally, these people may have an inappropriately jocular or giddy appearance, as in the case of a patient who chuckles inappropriately through a funeral service or other solemn occasion.
People diagnosed with this subtype also may have significant impairment in their ability to communicate effectively. At times, their speech can become virtually incomprehensible, due to disorganized thinking. In such cases, speech is characterized by problems with the utilization and ordering of words in conversational sentences, rather than with difficulties of enunciation or articulation. In the past, the term hebephrenic has been used to describe this subtype.
How Is It Diagnosed?
The general criteria for a diagnosis of schizophrenia must be satisified for disorganized schizophrenia. The personality of the person before the onset of the schizophrenia is often shy and solitary.
This subtype is diagnosed when the patient no longer displays prominent symptoms. In such cases, the schizophrenic symptoms generally have lessened in severity. Hallucinations, delusions or idiosyncratic behaviors may still be present, but their manifestations are significantly diminished in comparison to the acute phase of the illness.
Just as the symptoms of schizophrenia are diverse, so are its ramifications. Different kinds of impairment affect each patient’s life to varying degrees. Some people require custodial care in state institutions, while others are gainfully employed and can maintain an active family life. However, the majority of patients are at neither of these extremes. Most will have a waxing and waning course marked with some hospitalizations and some assistance from outside support sources.
People having a higher level of functioning before the start of their illness typically have a better outcome. In general, better outcomes are associated with brief episodes of symptoms worsening followed by a return to normal functioning. Women have a better prognosis for higher functioning than men, as do patients with no apparent structural abnormalities of the brain.
In contrast, a poorer prognosis is indicated by a gradual or insidious onset, beginning in childhood or adolescence; structural brain abnormalities, as seen on imaging studies; and failure to return to prior levels of functioning after acute episodes.
How Is It Diagnosed?
Residual schizophrenia is typically by diagnosed by the following symptoms:
- a. prominent “negative” schizophrenic symptoms, such as psychomotor slowing, underactivity, blunting of affect, passivity and lack of initiative, poverty of quantity or content of speech, poor nonverbal communication by facial expression, eye contact, voice modulation, and posture, poor self-care and social performance;
- b. evidence in the past of at least one psychotic episode meeting the diagnostic criteria for schizophrenia;
- c. a period of at least 1 year during which the intensity and frequency of florid symptoms such as delusions and hallucinations have been minimal or substantially reduced and the “negative” schizophrenic syndrome has been present;
- d. absence of dementia or other organic brain disease or disorder, and of chronic depression or institutionalism sufficient to explain the negative impairments.