Psychology
Subtypes of Schizophrenia
Subtypes of schizophrenia refer to the different classifications of the disorder based on symptom patterns. The main subtypes include paranoid, disorganized, catatonic, undifferentiated, and residual schizophrenia. Each subtype is characterized by distinct symptoms and behaviors, which can help in diagnosis and treatment planning for individuals with schizophrenia.
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12 Key excerpts on "Subtypes of Schizophrenia"
eBook - PDF- Gordon L. Flett, Nancy L. Kocovski, Gerald C. Davison, John M. Neale(Authors)
- 2018(Publication Date)
- Wiley(Publisher)
Individuals with paranoid schizophrenia are agitated, argumentative, angry, and some- times violent. They remain emotionally responsive, although they may be somewhat stilted, formal, and intense with others. They are also more alert and verbal than are people with other types of schizophrenia. Their language, although filled with references to delusions, is not disorganized. Additional Ways of Conceptualizing Hetero- geneity While perhaps useful from an heuristic perspec- tive, Kraepelin’s system of subtyping has not proved to be a useful way of dealing with the variability in schizophrenic behaviour. The DSM-IV-TR included other flawed subtypes in addition to the ones outlined above. The diagnosis of undiffer- entiated schizophrenia applies to people who meet the diag- nostic criteria for schizophrenia but not the criteria for any of the three subtypes. The diagnosis of residual schizophrenia is used when the client no longer meets the full criteria for schizo- phrenia but still shows some signs of the disorder. Despite the problems with subtyping systems, there is con- tinuing interest in differentiating the forms of schizophrenia. A radically different and promising approach focuses on schizo- phrenia subtypes that differ qualitatively in terms of neurocog- nitive features that involve brain abnormalities. Regarding the heterogeneity issue, Heinrichs and Awad (1993) conducted a cluster analysis that identified Subtypes of Schizophrenia based on performances on a battery of neuropsychological tests that Earlier, we mentioned that the heterogeneity of schizo- phrenic symptoms suggested the presence of subtypes of the disorder. Three types of schizophrenic disorders included in DSM-IV-TR—disorganized (hebephrenic), catatonic, and para- noid—were proposed initially by Kraepelin many years ago. The descriptions of Kraepelin’s original types demonstrate the great diversity of behaviour that relates to the diagnosis of schizo- phrenia.
eBook - PDFAbnormal Psychology
An Integrative Approach
- David Barlow, V. Durand, Stefan Hofmann, , David Barlow, V. Durand, Stefan Hofmann(Authors)
- 2017(Publication Date)
- Cengage Learning EMEA(Publisher)
484 C H A P T E R O U T L I N E Perspectives on Schizophrenia Early Figures in Diagnosing Schizophrenia Identifying Symptoms Clinical Description, Symptoms, and Subtypes Positive Symptoms Negative Symptoms Disorganized Symptoms Historic Schizophrenia Subtypes Other Psychotic Disorders Prevalence and Causes of Schizophrenia Statistics Development Cultural Factors Genetic Influences Neurobiological Influences Psychological and Social Influences Treatment of Schizophrenia Biological Interventions Psychosocial Interventions Treatment across Cultures Prevention 13 Schizophrenia Spectrum and Other Psychotic Disorders Nick Dolding/Getty Images Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-208 PERSPECTIVES ON SCHIZOPHRENIA 485 STUDENT LEARNING OUTCOMES* Perspectives on Schizophrenia A middle-aged man walks the streets of New York City with alumi-num foil on the inside of his hat so Martians can’t read his mind. A young woman sits in her college classroom and hears the voice of God telling her she is a vile and disgusting person. You try to strike up a conversation with the supermarket bagger, but he stares at you vacantly and will say only one or two words in a flat, toneless voice. Each of these people may have schizophrenia , the startling disorder characterized by a broad spectrum of cognitive and emo-tional dysfunctions including delusions and hallucinations, disor-ganized speech and behavior, and inappropriate emotions. Schizophrenia is a complex syndrome that inevitably has a devastating effect on the lives of the person affected and on family members. This disorder can disrupt a person’s perception, thought, speech, and movement: almost every aspect of daily functioning.
eBook - PDF- V. Durand, David Barlow, Stefan Hofmann, , V. Durand, David Barlow, Stefan Hofmann(Authors)
- 2018(Publication Date)
- Cengage Learning EMEA(Publisher)
444 12 Schizophrenia Spectrum and Other Psychotic Disorders CHAPTER OUTLINE Perspectives on Schizophrenia Early Figures in Diagnosing Schizophrenia Identifying Symptoms Clinical Description, Symptoms, and Subtypes Positive Symptoms Negative Symptoms Disorganized Symptoms Historic Schizophrenia Subtypes Other Psychotic Disorders Prevalence and Causes of Schizophrenia Statistics Development Cultural Factors Genetic Influences Neurobiological Influences Psychological and Social Influences Treatment of Schizophrenia Biological Interventions Psychosocial Interventions Treatment across Cultures Prevention Eekhoff Picture Lab/Blend Images LLC Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Perspectives on Schizophrenia • 445 A middle-aged man walks the streets of New York City with aluminum foil on the inside of his hat so Martians can’t read his mind. A young woman sits in her college classroom and hears the voice of God telling her she is a vile and disgusting person. You try to strike up a conversation with the super- market bagger, but he stares at you vacantly and will say only one or two words in a flat, toneless voice. Each of these people may have schizophrenia, the startling disorder char- acterized by a broad spectrum of cognitive and emotional dysfunctions including delusions and hallucinations, disor- ganized speech and behavior, and inappropriate emotions. Schizophrenia is a complex syndrome that inevitably has a devastating effect on the lives of the person affected and on family members.
eBook - PDFIntroduction to Psychiatry
Preclinical Foundations and Clinical Essentials
- Audrey Walker, Steven Schlozman, Jonathan Alpert(Authors)
- 2021(Publication Date)
- Cambridge University Press(Publisher)
Here the social worker dealing with the family is an important team member of the treatment team. Clinicians who care for patients with schizophrenia need to be skilled at treating all major domains of psychopathology, not just psychosis. Mood episodes (major depression and mania), anxiety disorders (especially panic attacks and obsessive compulsive disorder), and substance use are all highly comorbid with schizophre- nia and need to be adequately addressed. In addition, impulsivity and anger can be significant components of the clinical presentation. Finally, partial or poor treatment adherence is common in this condition and this is associated with poor outcomes. Another important clinical aspect of schizophrenia is its heterogeneity. Patients with this condition present with a variety of clinical pictures. Some have a classic paranoid psychosis with hallucinations and delusions but preserved cognition; others have poorly formed delusions but pronounced negative and cognitive symptoms; others still evolve in their presentation over time. Note that the symptomatic criteria for schizophrenia can be satisfied equally well by totally non-overlapping presenta- tions (e.g., in Table 5.1 criterion A, items (1+4) by one patient but (2+5) by another). Previous classification schemes had described schizophrenia subtypes based on this heterogeneity. DSM-5 no longer recognizes the historical Subtypes of Schizophrenia Introduction 113 (i.e., paranoid, hebephrenic, and catatonic), as they are unstable and as they do not adequately capture the diversity among patients with the condition. Instead, clinicians are asked to capture dimensions of psychopathology to describe individual patients. Description of Symptoms Positive symptoms include delusions, hallucinations, (formal) thought disor- der, and disorganized motor and social behavior. Delusions are false beliefs that cannot be attributed to the patient’s culture or background and are resistant to change.
eBook - PDFThe Troubled Mind
A Handbook of Therapeutic Approaches to Psychological Distress
- Susy Churchill(Author)
- 2020(Publication Date)
- Red Globe Press(Publisher)
176 THE TROUBLED MIND Positive symptoms are the delusions, hallucinations, very odd behaviour and disconnected speech (‘word salad’) that we immediately think of as ‘psychotic’. Delusions are thoughts and beliefs which most would consider unreal, and may be very bizarre: for example, that doctors and nurses are terrorists. Hallucinations are perceptions (auditory, visual, or through another sense) which occur without an external stimulus. Auditory hallucinations are the most frequent – ‘hearing voices’ – but this is not always due to psychosis (see e.g. www.hearing-voices.org). Schizophrenia This is likely to be diagnosed if the individual has shown at least a month of positive symptoms , and 6 months being obviously disturbed. DSM gives further descriptions for the subclasses of schizophrenia: paranoid , disorganised , catatonic , undifferentiated and residual . They suggest that individuals may show symptoms that fit more than one type, and that the dominant type may change over time. As with personality disorders, there is dissatisfaction in the psychiatric world with the validity of the subtypes, and an alternative dimensional approach is given in the research criteria. Catatonic type: this diagnosis is given whenever catatonic symptoms are present, regardless of other symptoms. As the name suggests, the person is likely to be immobile – but the classification also includes people who show unusually high levels of movement, stereotyped or bizarre movements, or copy other people’s movements (echopraxia) or speech (echolalia). Disorganised (hebephrenic) type : this is diagnosed when catatonic symp-toms are not dominant, but the individual shows disorganised speech and behaviour, together with flat or inappropriate emotional responses. This diagnosis is more common in people who started displaying psychotic symptoms early, and is associated with poorer outcomes: periods of remis-sion are rarer. Our student client Martin would appear to meet some of these criteria.
- Michael B. First, Allan Tasman(Authors)
- 2013(Publication Date)
- Wiley(Publisher)
CHAPTER 25 Schizophrenia and Other Psychoses Schizophrenia Schizophrenia is the most severe and debilitating mental illness, and it has long been the focus of medical, scientific, and societal attention. The term Schizophrenia is relatively new to our vocabulary, yet chronic psychotic illnesses have most likely been in existence throughout civilized times. The words used historically to describe psychotic symptoms included madness, folie, insanity , and dementia. They depict a constellation of symptoms that have been poorly understood and shrouded in mystery and fear. Even in the twenty-first century, the layperson’s conception of Schizophrenia is influenced by these early beliefs. It is only with our modern under- standing of the pathophysiology and manifestations of this debilitating illness that the stigmata associated with Schizophrenia can be overcome. Diagnosis DSM-IV-TR Diagnostic Criteria 295.xx Schizophrenia A. Characteristic symptoms: Two (or more) of the follow- ing, each present for a significant portion of time during a 1-month period (or less if successfully treated): (1) delusions (2) hallucinations (3) disorganized speech (e.g., frequent derailment or incoherence) (4) grossly disorganized or catatonic behavior (5) negative symptoms, i.e., affective flattening, alogia, or avolition Note: Only one criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other. B. Social/occupational dysfunction: For a significant por- tion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interper- sonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in child- hood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).
eBook - PDF- Jair C. Soares, Samuel Gershon, Jair C. Soares, Samuel Gershon(Authors)
- 2003(Publication Date)
- CRC Press(Publisher)
6 Classification of Schizophrenia and Related Psychotic Disorders TONMOY SHARMA and PRIYA BAJAJ Clinical Neuroscience Research Centre, Stonehouse Hospital, Dartford, Kent, England I. INTRODUCTION The need for a classification of mental disorders has been clear throughout the history of medicine, but there has been little agreement on which disorders should be included and the optimal method for their organization. The many nomenclatures that have been developed during the past two millennia have differed in their relative emphasis on phenomenology, etiology, and course as defining features. Some systems have included only a handful of diagnostic categories whereas others have included thousands. Moreover, the various systems for categorizing mental disorders have differed with respect to whether their principal objective was for use in clinical, research, or statistical settings [1]. Attitudes to psychiatric classification have also undergone a revolution in the last generation. In the 1950s and 1960s, psychiatric diagnoses did not occupy center stage in clinical practice. Their reliability was known to be low; it was known that key diagnostic terms like schizophrenia had different meanings in dif-ferent parts of the world. On the other extreme, there were some who argued that diagnostic categories should be abandoned and they believed that all patients require the same treatment—the ‘‘moral regime’’ of the asylum for Neumann and Prichard in the 19th century, and psychotherapy of Rogers and Menninger in the 20th century [2]. However, a clear definition and accurate classifica-tion of a disorder are the first steps in any systematic attempt to understand the pathophysiology and etiol-ogy of the disorder. The revolution in biological psy-chiatry can, in part, be attributed to advances in nosology [3].
eBook - PDF- P. Berner, E. Gabriel, H. Katschnig, W. Kieffer, K. Koehler, G. Lenz(Authors)
- 1992(Publication Date)
- Cambridge University Press(Publisher)
On the other hand non-symptomatological criteria, especially concerning illness course, are not to be considered for classification. This concept of schizophrenia is thus a broad one, based partly on symptomatology and partly on the degree (psychotic) of severity. Its position between organic and affective psychoses reflects traditional hierarchical assumptions. The symptoms concerned reflect in part disturbances of experience and in part disturbances of behavior, gathered partly from the patient's reports and partly from the patient's behavior. The fourth-digit order concerns the identification of subgroups. Its application is facilitated by more or less precise descriptions and a listing of syndromatological notions for subgroup inclusion and/or exclusion. Above all this is of consequence for the delimitation of paranoid schizo- phrenia from other paranoid psychoses (ICD 297) and the delimitation of latent schizophrenia from schizoid personality (ICD 301.2). Criteria other than symptomatological ones appear in the description of the subgroups, especially those to do with illness chronology. These can refer on the one hand to the form the illness presented at onset or during its course, or on the other hand to the age of predilection: 295.0 Simple type Insidious onset 295.1 Hebephrenic type Onset mainly between the ages of 15 and 25 years 295.3 Paranoid type Relatively stable 295.4 Acute schizophrenic episode Acute onset, remission mostly within a few weeks or months 32 B5 ICD, 8th and 9th revisions 295.6 Residual schizophrenia Chronic form following acute episodes 295.7 Schizoaffective type Remission without permanent defect Such indications, however, are not systematically offered.
eBook - PDFClinical Assessment Workbook
Balancing Strengths and Differential Diagnosis
- Elizabeth Pomeroy(Author)
- 2014(Publication Date)
- Cengage Learning EMEA(Publisher)
Schizophrenia may manifest as severe disruptions in thinking, gross disorganization in thoughts, or may involve delusions (i.e., systems of false beliefs that vary in elaborateness but are not open to reason or appeal). The client may experience severe perceptual disturbances such as hallucinations (i.e., sensory experiences in the absence of sensory input). The most common hallucinatory ex-periences are auditory, in which the client hears one or more voices in much the same manner, as he or she would hear someone else talking. The remaining symp-toms are sometimes labeled “negative” in that they represent the relative absence of things like affect, motivation, and/or interaction (APA, 2013). For a diagnosis of schizophrenia, two or more “active-phase” symptoms must occur for a majority of a one-month period (unless responding positively to treatment) with the distress lasting at least 6 months. With modern treatment, it is unlikely that a single episode would encompass this entire time framework. Symptoms include: delusions (i.e., systems of false beliefs that vary in elaborateness but are not open to reason or appeal); hallucinations (i.e., sensory experiences in the absence of sensory input); “disorganized thinking/speech (i.e., frequent derailment or incoherence); grossly disorganized or catatonic behavior; and, negative symptoms (i.e., diminished emotional expression or avolition)” (APA, 2013, p. 99). Moreover, at a minimum, one of the two required symptoms of schizophrenia must be delusions, hallucinations, and/or disorganized speech. Changes to the diagnostic criteria for schizophrenia from earlier editions include the removal of: distinct clinical subtypes (i.e., disorganized, catatonic, paranoid, and undifferentiated) and the special treatment of bizarre delusions. Also, a specifier for catatonic features was added along with dimensional assessment measures in Section III for psychopathology (APA, 2013).
- David Sue, Derald Wing Sue, Diane Sue, Stanley Sue(Authors)
- 2016(Publication Date)
- Cengage Learning EMEA(Publisher)
Schizophrenia is a serious mental illness on the severe end of the schizophrenia spectrum . The disorders on the schizophrenia spectrum involve symptoms such as psychosis (an impaired sense of reality that frequently involves hallucinations and/or delusions); impaired cognitive processes (including disor-ganized speech); unusual or disorganized motor behavior; and problematic be-haviors that affect social interactions. People who develop these symptoms often mention that the experience is very confusing. Initial psychotic episodes can be particularly scary because the person has no explanation for the symptoms. As one individual observed, “I didn’t understand what was happening to me, I didn’t understand what I was seeing.” (Tan, Gould, Combes, & Lehmann, 2014, p. 87). In this chapter, we begin with an in-depth discussion of symptoms associated with schizophrenia and other disorders on the schizophrenia spectrum. We then discuss the diagnosis, etiology, and treatment of schizophrenia and conclude with an overview of other disorders on the schizophrenia spectrum. Symptoms of Schizophrenia Spectrum Disorders The symptoms associated with schizophrenia spectrum disorders fall into four categories: positive symptoms, psychomotor abnormalities, cognitive symptoms, and negative symptoms . Positive Symptoms Positive symptoms associated with schizophrenia spectrum disorders involve delusions, hallucinations, disordered thinking, incoherent communication, and bizarre behavior. The term “positive symptoms” refers to behaviors or experiences associated with schizophrenia that are new to the person. These symptoms can range in severity, and can persist or fluctuate. In the case above, Alexis experienced two positive symptoms: auditory hallucinations (hearing voices) and a delusion that three people were following him, keeping him awake and sending vibrations into his body.
eBook - PDF- Daniel Fung, Cai Yiming;;;(Authors)
- 2008(Publication Date)
- WSPC(Publisher)
17 Psychotic Disorders Ong Say How No psychiatric illness other than depression has had so big an impact on society as well as on a personal level as this unique group of men-tal disorders. Psychotic disorders, particularly schizophrenia, have been studied for years, and have in the process raised more questions than answers. Fortunately, through all the research done so far, we have gained a wealth of information about their biological origins and psycho-social effects. In addition, new technology has helped propel advances in the area of pharmacological research. “Psychosis” literally means a severe disturbance in one’s “reality-testing”. Simply put, it is a mental condition in which the individual suffering from it becomes “out of touch with reality”. Broadly used in the past to encompass a wide variety of psychological symptoms, psychosis now denotes the presence of a very specific set of symp-toms, like hallucinations and delusions. It was not until 1919 that Kraepelin first started describing a certain group of patients with a psychosis that typically began in early adulthood and ran a progres-sively deteriorating course. He named it “dementia praecox”, which Bleuler redefined as “schizophrenia”, a condition whose fundamen-tal deficits lie in the “splitting or disconnection of normally integrated cognitive functions”. Both these definitions, though they are histori-cally important and have helped shape our understanding of the dis-ease condition, are no longer in use in our modern diagnostic 193 systems. While data derived from studies conducted before 1980 had methodological flaws that unfortunately limited the usefulness of the diagnostic criteria, the advent of DSM-III and the current DSM-IV has allowed categorisation of psychotic disorders and schizophrenia to be clearer for clinician communication and scien-tific research.
eBook - PDF- Ronald Comer, Elizabeth Gould, Adrian Furnham(Authors)
- 2014(Publication Date)
- Wiley(Publisher)
H. Freeman and Company, p. 96. Used with permission. antipsychotic drugs medications that help remove the symptoms of schizophrenia. Before You Go On What Do You Know? 16. What is a psychosis? 17. What are the positive symptoms of schizophrenia? The negative symptoms? The psychomotor symptoms? 18. What biochemical abnormalities and brain structures have been associated with schizophrenia? What Do You Think? We noted in this section that if one identical twin develops schizophrenia, there is a 48% chance that the other twin will do so as well. Discuss how this would support the diathesis-stress model. CHAPTER 19 PSYCHOLOGICAL DISORDERS 568 Other Psychological Disorders LEARNING OBJECTIVE 6 Discuss the features and possible causes of somatoform, dis- sociative and personality disorders. This chapter will conclude by looking briefly at three addi- tional disorder categories: somatoform disorders, disso- ciative disorders and personality disorders. Each of these disorder categories is problematic, with personality disor- ders having a great deal of overlap and, more fundamentally, somatoform and dissociative disorders being challenged for their very status as diagnostic categories (Holmes, 2010; Spanos, 1996) Somatoform Disorders When a presented physical ailment has no detectable medi- cal cause, it is suggested that the sufferer may be experienc- ing a somatoform disorder , a pattern of physical complaints with largely psychosocial causes. It is assumed that individuals do not consciously want or purposely produce their symptoms: they almost always claim to believe that their symptoms are genuinely medical (Lah- mann et al., 2010). In conversion dis- order, somatization disorder and pain disorder associated with psychological factors, clients present with a change in physical functioning. In hypochondriasis and body dys- morphic disorder, healthy individuals worry that there is something physically wrong with them without medical confirmation.
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