Schizophrenia Types

  • According to the DSM IV, Schizophrenia is classified into 5 types, paranoid, catatonic, disorganized, undifferentiated and residual.
  • Schizotype is a personality disorder of DSM-IV which is not classified as PD & is placed with schizophrenia in ICD
  • F20-F29 Schizophrenia, Schizotypal and Delusional Disorders
  • F20 Schizophrenia
  • F20.0 Paranoid schizophrenia (best prognosis)(most common)
  • F20.1 Hebephrenic/disorganized schizophrenia
  • F20.2 Catatonic schizophrenia(most common)
  • F20.3 Undifferentiated schizophrenia
  • F20.4 Post-schizophrenic depression
  • F20.5 Residual schizophrenia
  • F20.6 Simple schizophrenia
  • F20.8 Other schizophrenia
  • F20.9 Schizophrenia, unspecified
Paranoid Schizophrenia
  • Paranoid schizophrenia is characterized mainly by Grimacing ,delusions of persecution, feelings of passive(somatic passivity) or active control, feelings of intrusion,self reference and often by megalomanic tendencies also.
  • The delusions are not usually systemized too much, without tight logical connections and are often combined with hallucinations of different senses, mostly with hearing voices. Disturbances of affect, volition and speech, and catatonic symptoms, are either absent or relatively inconspicuous
  • Paranoid schizophrenia is mimicked by intake of Amphetamine
Hebephrenic Schizophrenia
  • Hebephrenic schizophrenia is characterized by disorganized thinking with blunted and inappropriate emotions.
  • It begins mostly in adolescent age, the behavior is often bizarre.
  • There could appear inappropriate laugh and joking, pseudophilosophical brooding and sudden impulsive reactions without external stimulation.
  • There is a tendency to social isolation.
  • Early onset with poor prognosis
  • Usually the prognosis is poor because of the rapid development of "negative" symptoms, particularly flattening of affect and loss of volition.
  • Hebephrenia should normally be diagnosed only in adolescents or young adults.
  • Denoted also as disorganized schizophrenia
Catatonic Schizophrenia
  • Catatonic schizophrenia is characterized mainly by motoric activity, which might be strongly increased (hypekinesis) or decreased (stupor), or automatic obedience and negativism. Late onset and good prognosis
  • Catatonic features are seen in schizophrenia they are also seen in Severe depression & Conversion disorder
  • Defect of conation
  • Grimacing (carrying out odd, exaggerated actions)and Mannerism
  • We recognize two forms:
  1. Productive form — which shows catatonic excitement, extreme and often psychomotor aggressive activity. Treatment by neuroleptics or by electroconvulsive therapy. 
  2. Stuporose form — characterized by general inhibition of patient’s behavior or at least by retardation and slowness, followed often by mutism, negativism, fexibility cerea or by stupor. The consciousness is not absent.
Undifferentiated Schizophrenia
  • Psychotic conditions meeting the general diagnostic criteria for schizophrenia but not conforming to any of the subtypes in F20.0-F20.2, or exhibiting the features of more than one of them without a clear predominance of a particular set of diagnostic characteristics
  • This subgroup represents also the former diagnosis of atypical schizophrenia.
Post Schizophrenic Depression
  • A depressive episode, which may be prolonged, arising in the aftermath of a schizophrenic illness.
  • Some schizophrenic symptoms, either positive or negative, must still be present but they no longer dominate the clinical picture.
  • These depressive states are associated with an increased risk of suicide.
Residual Schizophrenia
  • A chronic stage in the development of schizophrenia with clear succession from the initial stage with one or more episodes characterized by general criteria of schizophrenia to the late stage with long-lasting negative symptoms and deterioration (not necessarily irreversible).
Simple Schizophrenia
  • Included only under the ICD 10 classification
  • Simple schizophrenia is characterized by early and slowly developing initial stage with growing social isolation, withdrawal, small activity, passivity, avolition and dependence on the others.
  • The patients are indifferent, without any initiative and volition.
  • There is not expressed the presence of hallucinations and delusions.
Early-OnsetSchizophrenia Late — OnsetSchizophrenia Very Late—OnsetSchizophrenia- LikePsychosis
Age of onset Younger thanage 40 Middle age(age 40 to 65) Late life (olderthan age 65)
Predominant gender Men Women Women
Paranoid subtype Common Very Common Common
Negative Symptoms Marked Present Absent
Thought disorder Present Present Absent
Minor physicalanomalies Present Present Absent
Brain structure abnormalities (e.g.strokes,tumors) Absent Absent Marked
Neuropsychological impairment:LearningRetention MarkedAbsent PresentAbsent Probably MarkedProbably marked
Progressive cognitivedeterioration Absent Absent Marked
Family history ofschizophrenia Present Present Absent
Early childhoodmaladjustment Present Present Absent
Risk of tardivedyskinesia Present Present Marked
Daily neuroleptic dose High Lower
Type I Schizophrenia is characterised by:
  • Positive symptoms
  • Normal brain structure
  • Absence of intellectual impairment
  • Good response to neuroleptics
Type II Schizophrenia is characterised by :
  • Prominent negative symptoms,
  • Intellectual deterioration,
  • Enlarged cerebral ventricles and reduced cerebral volume
  • Poor response to neuroleptics.
  • Insidious onset and poor long-term outcome
Exam Question
  • Type II Schizophrenia is characterised by prominent negative symptoms, intellectual deterioration, enlarged cerebral ventricles and poor response to neuroleptics. Most common type of schizophrenia is paranoid
  • Paranoid Schizophrenia is associated with best prognosis
  • Catatonic features are seen in schizophrenia they are also seen in Severe depression & Conversion disorder
  • Schizotype is a personality disorder of DSM-IV which is not classified as PD & is placed with schizophrenia in ICD
  • Somatic passivityDelusions of control, persecution and self reference is a feature of Paranoid schizophrenia
  • Patient presents with psychomotor acitivity,Stuptor, waxy flexibility, negativism & rigidity Diagnosis is Catatonic schizophrenia
  • Grimacing and Mannerism is Catatonic Schizophrenia
  • Schizophrenia with late onset and good prognosis is Catatonic SZP
  • In Schizophrenia early onset with poor prognosis is seen in Hebephrenic
  • Defect of conation is typically seen in Catatonic schizophrenia
  • Paranoid schizophrenia is mimicked by intake of Amphetamine
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