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Types of Schizophrenia

DSM-IV distinguishes between several different categories of schizophrenia. The categories are not mutually exclusive. Sometimes an individual shows symptoms of more than one type.

What is undifferentiated schizophrenia? Disorganized schizophrenia?

Undifferentiated schizophrenia is a miscellaneous category in DSM-IV. It is used for people who have suffered a psychotic break (lose contact with reality) but do not show enough other symptoms to permit classification into one of the other categories.

The disorganized type (formerly called hebephrenic) schizophrenic shows disorganized speech and behavior as well as flat or inappropriate affect. (The word affect is pronounced AFF-ect in this context and means emotion.) A person with flat affect seems emotionless. A person with inappropriate affect may weep uncontrollably at something that seems harmless, or laugh hysterically at nothing in particular. This type of schizophrenic is called "disorganized" because a primary symptom of the problem is difficulty in performing ordinary daily activities such as showering or getting dressed. Of all the types of schizophrenia, the prognosis (future outlook) for the disorganized type is poorest.

What are clang associations?

Loosely associated speech is perhaps the most striking feature of disorganized schizophrenia. This speech is sometimes described as a "word salad." It wanders all over the place, following any association that comes along. It may contain clang associations, which are strings of words having a similar sound.

Bootzin and Acocella (1984) cite the example of a patient who replied to the greeting of his doctor (Dr. Richard Hagen of Florida State University) as follows:

Well, when we was first bit on the slit on the rit and the man on the ran or the pan on the ban and the sand on the man and the pan on the ban and the can on the man on the fan on the pan. (p.341)

All of this was spoken "very rhythmically, beginning slowly and building up to such a rapid pace that the words could no longer be understood."

What is waxy flexibility?

Catatonic schizophrenics have disordered motor activity. They can be wildly active with inappropriate and purposeless activity, or they may be completely still. The still reaction is best known and is what most people mean by a catatonic state. It is also called waxy flexibility because the individual acts like a wax figure, holding perfectly still, yet remains flexible. One can reposition the limbs of a person in a catatonic state, and that person will keep the same position—or the limbs will gradually fall due to muscle fatigue and the effects of gravity—while the catatonic person remains staring straight ahead, hardly blinking, not reacting to anything.

What are some examples of animals showing catatonic states?

Catatonic-like states occur in non-human animals, too. A rat injected with endorphins will enter a "profound catatonic state" (Bloom, Segal, & Guilleman, 1976). The researchers note the "total absence of spontaneous movement" and the fact that these "would remain in abnormal body positions...for indefinite periods" (p.631).

In both humans and animals, catatonic states seem to be triggered by stress. Humans sometimes go into catatonia after a disastrous failure of business or romance. Newton and Gantt (1968) described a dog that went into a catatonic state whenever approached by a strange human. In this state the dog showed the usual waxy flexibility of catatonia. Its limbs could be placed into strange positions that it would maintain for ten minutes before "sinking gradually to the floor."

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