Schizophrenia is a chronic illness that can affect emotions, thought processes, and relationships.
It’s possible that one person could display symptoms of schizophrenia attributed to multiple subtypes over the course of their illness.
Symptoms may come and go and include:
- issues with concentration or focus
- a lack of emotion, or “flat effect”
The symptoms of schizophrenia will help a doctor determine the type of schizophrenia a person has.
These types of schizophrenia (or subtypes) were once defined according to the most significant characteristics shown in each person. In 2013, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5)
Though these specific subtypes are no longer used in a clinical diagnosis, doctors sometimes use them to aid and inform a treatment plan, sometimes using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) as an additional resource.
Though these subtypes aren’t used for clinical diagnosis anymore, various subtypes are sometimes used to help inform a diagnosis.
The paranoid subtype (also known as paranoid schizophrenia) is auditory hallucinations or delusional thoughts about persecution or conspiracy.
When the subtypes were used for diagnosis, paranoid schizophrenia was the most common subtype.
Symptoms of the paranoid subtype include those shared among a few types, including:
- trouble forming words and speech
- echoing or parroting speech (echolalia)
- issues with concentration
- issues with behavior such as impulse control
- lack of emotion, or a flat affect
People with this subtype may sometimes engage more easily in work and relationships than people with other subtypes of schizophrenia.
Though the reasons are not entirely clear, some people with this subtype don’t show symptoms until later in life and may have achieved a higher functioning level before their illness.
When symptomatic, a person’s temperament and behavior are often related to their symptoms. What they may hear or see and their delusional beliefs often form a coherent and consistent “story,” unlike hallucinations or delusions in other subtypes.
For example, people who have a delusion that they are being persecuted unjustly may be easily angered.
The disorganized subtype’s predominant symptom is disorganization of thought processes.
Hallucinations and delusions may be less pronounced and do not usually form a coherent story, although there may be some evidence of these symptoms.
Symptoms of this subtype include:
- issues with speech and communication
- disorganized thoughts
- flat or blunted affect
- emotions and reactions that don’t match the situation
- issues managing daily activities
People with disorganized symptoms may have difficulty navigating daily life, such as maintaining work or social relationships.
Even more routine tasks, such as dressing, bathing, or brushing teeth, can be troublesome.
Emotions may be significantly impacted. For example, someone living with disorganized schizophrenia may appear to have little or no emotions.Mental health professionals refer to this as a blunted or flat affect.
At other times, they may seem emotionally unstable, or their emotions may not seem appropriate for the situation.
People living with symptoms of this subtype also may not be able to communicate effectively. At times, their speech may become less understandable due to disorganized thinking — it may be jumbled, or they may speak in sentences that don’t make sense.
The predominant clinical features in the catatonic subtype involve problems with movement and responsiveness to other people or everyday situations. These include:
- lack of movement, as in a catatonic stupor or immobility
- mimicking actions, speech, or movements (echopraxia)
- echoing or parroting speech (echolalia)
- symptoms of mutism, or loss of speech
- stereotypic behavior, or repeated actions that appear purposeless
Those living with symptoms of this subtype may significantly reduce their activity, even to the point that voluntary movement stops.
Many with this subtype may be mistaken as blind, deaf, or unable to speak because they may remain “stiff” or “frozen” when others attempt to interact with them.
Also, their activity can increase significantly, known as catatonic excitement. These symptoms can also occur in several other conditions.
People living with the illness may voluntarily assume unusual body positions or unusual facial expressions or arm and leg movements.
The undifferentiated subtype was diagnosed when people had symptoms of schizophrenia that are not well-formed or specific enough to classify.
Symptoms can fluctuate at different times, resulting in uncertainty in subtype classification. Individuals can also sometimes show symptoms that may fit a few subtypes.
With the removal of specific subtypes within the diagnosis, this subtype now indicates that various symptoms are present.
The person experiencing this subtype no longer displays prominent symptoms, or they have become less severe.
The person may experience a few mild symptoms or patterns of disorganized thinking or thoughts others find unusual.
These thought patterns often are not severe enough to disrupt the person’s life unless they experience periods where more prominent symptoms return.
This designation isn’t used often due to fluctuations in symptoms throughout the course of the illness.
Schizophrenia isn’t preventable, but it can be managed with treatment, especially when symptoms are understood and treated early.
Different kinds of symptoms affect each person’s life to varying degrees. Some people require in-patient care. Others can maintain employment and an active social life. Most people have symptoms somewhere in between.
Treatment usually consists of medication management and may include:
- emotional skills training
- family therapy
- specialized forms of cognitive-behavioral therapy (CBT)
- and/or community integration and job training
Talk with your healthcare team about a treatment plan that is best for you.
Current treatments have