The kinds of symptoms that are utilized to make a diagnosis of schizophrenia differ between affected people and may change from one year to the next within the same person as the disease progresses. Different subtypes of schizophrenia are defined according to the most significant and predominant characteristics present in each person at each point in time. The result is that one person may be diagnosed with different subtypes over the course of his illness.
Schizophrenia: Paranoid Subtype
The defining feature of the paranoid subtype (also known as paranoid schizophrenia) is the presence of auditory hallucinations or prominent delusional thoughts about persecution or conspiracy. However, people with this subtype may be more functional in their ability to work and engage in relationships than people with other subtypes of schizophrenia. The reasons are not entirely clear, but may partly reflect that people suffering from this subtype often do not exhibit symptoms until later in life and have achieved a higher level of functioning before the onset of their illness. People with the paranoid subtype may appear to lead fairly normal lives by successful management of their disorder.
Paranoid schizophrenia is the most common subtype.
People diagnosed with the paranoid subtype may not appear odd or unusual and may not readily discuss the symptoms of their illness. Typically, the hallucinations and delusions revolve around some characteristic theme, and this theme often remains fairly consistent over time. A person’s temperaments and general behaviors often are related to the content of the disturbance of thought. For example, people who believe that they are being persecuted unjustly may be easily angered and become hostile. Often, paranoid schizophrenics will come to the attention of mental health professionals only when there has been some major stress in their life that has caused an increase in their symptoms. At that point, sufferers may recognize the need for outside help or act in a fashion to bring attention to themselves.
Since there may be no observable features, the evaluation requires sufferers to be somewhat open to discussing their thoughts. If there is a significant degree of suspiciousness or paranoia present, people may be very reluctant to discuss these issues with a stranger.
There is a broad spectrum to the nature and severity of symptoms that may be present at any one time. When symptoms are in a phase of exacerbation or worsening, there may be some disorganization of the thought processes. At this time, people may have more trouble than usual remembering recent events, speaking coherently or generally behaving in an organized, rational manner. While these features are more characteristic of other subtypes, they can be present to differing degrees in people with the paranoid subtype, depending upon the current state of their illness. Supportive friends or family members often may be needed at such times to help the symptomatic person get professional help.
Schizophrenia: Disorganized Subtype
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.