TYPES OF SCHIZOPHRENIA

schizophrenia

Types of Schizophrenia - Tulasi Healthcare

Schizophrenia is a syndrome that includes a vast variety of unusual behaviours and disruptions in how people think, feel and perceive things. It is a severe and chronic mental illness that makes it challenging for a person to differentiate between real and misleading perceptions and ideas.

It entails detachment from reality and other individuals and a person suffering from the condition is prone to perceive reality in a manner that appears strange to others. Since, it leads to disturbance in overall functioning of an individual, rehabilitation becomes a necessary step to help individuals lead a meaningful life. Schizophrenia involves poor insight, difficulties in paying attention, disturbance in understanding, processing and expressing emotions and disturbance in behavior. It typically impairs personal, social, and professional life.

Schizophrenia can be divided into several types and each type has its own clinical manifestations.

Symptoms can be divided into three domains:

  • positive symptoms
  • negative symptoms
  • cognitive symptoms

Positive Symptoms

Positive signs of schizophrenia refer to the presence of certain behaviours that are typically absent in those without the illness. Positive symptoms can have a sudden onset and usually have a better prognosis.

They consist of:

  • Delusions
  • Hallucinations
  • Distorted thinking
  • Erratic bodily movements

Delusions

A delusion is a belief that the person considers to be true despite clear evidence against it. It is based on a flawed or implausible premise. They are persistent incorrect beliefs that are believed even when there is substantial evidence to show that they are false. The most typical type is delusion of persecution wherein a person thinks they are being attacked or tormented by someone or something.

Hallucinations

Hallucinations involves perceiving  sounds, tastes, smells, or sensations are that not real. They give out an impression akin to that of everyday perceptions and are vivid and precise. The most typical hallucination in schizophrenia and other similar diseases is auditory hallucinations, or hearing voices, although they can occur in any sensory modality.

Unorganized thought

This entails having trouble structuring your thoughts, pausing in the midst of a conversation, or making up terms that are incomprehensible to other people.The thinking pattern appears unreasonable to others.

Abnormal movement of the body

Unusual body activities can occur in people, including:

  • Stereotypical movements: This involves repetition of specific actions.
  • Catatonia: The inability to respond to the surroundings and others.

Negative Symptoms

Negative symptoms are behaviours that are absent or underdeveloped. They develop gradually and have a poor prognosis.

This includes:

  • Inability to express emotions
  • Lack of social involvement, which includes speaking to others rarely, even in circumstances where it might be crucial
  • Alogia-Problem with spontaneous speech
  • Problems organizing, sticking with an activity, or withdrawal from interests
  • Anhedonia-difficulty in carrying out day to day tasks

 

Schizophrenia also affects our cognitive functions and leads to issues with decision-making and information processing; problems in applying the acquired knowledge, difficulty in concentration and sustaining attention.

Over time, symptoms might change in nature and severity with periods when they get worse and times when they are in remission.

Types of Schizophrenia

  • Paranoid Schizophrenia

This is the most prevalent type of schizophrenia.This is the most prevalent type of schizophrenia. Positive symptoms, or the appearance of  characteristics, thoughts, or actions, that were previously not noticeable are the main component of paranoid schizophrenia. Hallucinations and/or delusions are among the symptoms, however communication and emotional expression are less likely to impacted. The person develops a strong mistrust for others and may claim that other people are spying on them, following them, poisoning them, or otherwise influencing them. It also involves difficulty in critical evaluation, unpredictable and erratic behaviour is also  present.   Their overall functionality is higher that those of other subtypes and distinguished by intact cognitive abilities, and their prognosis is typically better.

  • Heberprenic schizophrenia

This affects mainly individuals aged between 15 and 25 years.Disorganized actions and ideas, as well as fleeting delusions and hallucinations, are indicators of this type. Speech becomes incoherent and it is challenging for other people to comprehend what you say.

People with disorganised schizophrenia frequently display little to no emotion in their mannerisms, speech tone, or facial expressions.

People are likely to become indifferent emotionally, indulge in inappropriate laughter. Speech is difficult to comprehend and may include childlike giggles, and the repetition of the same words etc. Thought process becomes disconnected and behaviour is odd and peculiar. Behaviour pattern involves talking to oneself, crying and laughing out of the blue etc.

While hallucinations and delusions may be present, they are not logical or structured into a “narrative,” as in paranoid schizophrenia. A serious impairment in one’s capacity to care for oneself and their inability to carry out daily activities is present.

  • Catatonic schizophrenia

This is characterized by movements that are unusual, constrained, and abrupt.  Alternating between hyperactivity and a lack of responsiveness is involved. Some patients might not move at all and respond to instructions minimally, while others may show odd and bizzare behaviours like echolalia and echopraxia. A few seconds, minutes, an hour, or even a day could pass while in this state.

 In a catatonic stupor, the patient adamantly rejects any attempt to move them, may become silent, opposes all efforts to feed them, and won’t agree to the smallest request. May abruptly change from a state of stupor to one of intense excitement, and may also turn violent, including shouting, talking incoherently, engaging in self harm, and attacking others.

Certain symptoms involve:

  • Catalepsy: Rigid muscles and a lack of reaction to outside stimuli 
  • Waxy flexibility: The individuals stays in an unusual position for an extremely lengthy duration. 
  • Stupor: A general lack of response to stimuli 
  • Overactive motor behaviour: Seemingly aimless movements that is unaffected by outside stimuli 
  • Overactive motor behaviour: Seemingly aimless movements that is unaffected by outside stimuli  Extreme negativity: Refusal to follow any directions  
  • Posturing: The willful adoption of unsuitable or peculiar positions 
  • Stereotypical actions repetitive, unconscious bodily actions like rocking 
  • Repeating what others have said, or echolalia
  • Echopraxia: The tendency to mimic others’ movements

Residual schizophrenia

Residual schizophrenia is diagnosed when a person has had at least one episode of schizophrenia but no longer exhibits substantial positive symptoms (hallucinations, delusions), or only to a much reduced extent, such as disorganized speech or behaviour. Individuals with this subtype exhibited mostly negative symptoms such social disengagement, apathy, or slower way of speaking, a lack of interest in life, difficulties expressing  feelings, feeling uninterested in activities, inability to make  plans, difficulty finding pleasure, etc.

Residual schizophrenia may have an effect on a person’s ability to function in their personal, social, professional, and educational spheres. Symptoms typically began to show up in late adolescence or early adulthood. The initial signs might have manifested as mild interpersonal problems, a lack of drive, or unsatisfactory academic results.

Simple schizophrenia

Simple schizophrenia is marked by negative symptoms such avolition, inactivity, loss of pleasure, restricted affect display, lack of drive, lack of motivation, and decreased activity whereas positive symptoms like hallucinations, delusions, and disorganised thinking are rarely found.

Undifferentiated schizophrenia

Undifferentiated schizophrenia is a diagnosis made if an individual exhibits symptoms from multiple subtypes of schizophrenia but not enough to place them in another subtype.

Treatment

Due to the fact that schizophrenia usually manifests in early adulthood, those who suffer from it frequently benefit from admission at a psychiatric hospital and rehabilitation. Rehabilitation is a process wherein a collaborative team of professionals such as psychiatrists, psychologists, social workers work together to help the individual resume his/her normal level of functioning.

The goal of rehabilitation is to focus on the recovery from the mental illness, managing relapses in the longer term and achieving better quality of life.

Since the symptoms can be exceedingly disturbing and incapacitating for the individual, admission to a psychiatric hospital and long-term intervention strategies can assist people in achieving their highest degree of functioning in society and for enhancing their level of well-being. Intervention strategies involve a combination of pharmacological management and psychotherapy. Cogntive behavioural therapy, cognitive rehabilitation, psychoeducation, social skills training, and family interventions are among treatment options.

Individuals can develop social skills, manage stress, recognize early indicators of relapse, and extend the duration of remission with the aid of therapy and psychosocial assistance. This further helps them to develop essential skills to manage life stressors, accomplish educational or occupational goals, and maintain a job.

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