Schizophrenia is a disease of neurological origin, resulting from dysfunction and atrophy of key structures in the brain (See Causes).  As the brain loses mass, the chemical balance is upset and psychiatric symptoms begin to appear.  There is a general diagnostic criterion for schizophrenia used by psychiatrists and psychologists to guide care.  Once a diagnosis is made, schizophrenia is further classified into subtypes of paranoid type, disorganized type, catatonic type, undifferentiated type or residual type.  Below are the diagnostic criteria for schizophrenia and each of its subtypes.

General Diagnostic Criteria

·        Two of the following, present for most of the time for at least a month:  delusions, hallucinations, peculiar speech patterns (see below for more information), or symptoms that interfere with daily functioning (i.e. unmotivated to bathe, shop, leave the home, engage in pleasurable activities, etc.).

·        Decline in social, work or self-care functioning

·        Signs that have been developing and persistent over at least a six month period

·        Symptoms cannot be attributed to another mental health problem (like bipolar disorder)

·        Symptoms cannot be attributed to substance use

Paranoid Type Schizophrenia: includes the above plus…

·        Auditory hallucinations or delusions

·        Any of the following behaviors:  aggression, inability to sit still or pay attention to others due to agitation,  purposeless activity or movements like grimacing or posturing, imitation of another person’s movements and gestures, behavior that is more child-like than previously observed, purposeless movements like pulling at clothes, crossing/uncrossing arms, etc., alertness or sustained attention as if expecting something important or frightening to happen, and/or holding a body part in an odd or unusual position for a long period of time (like a statue).

·        Use of any of the following speech patterns:  parroting another person’s words (echolalia), providing extremely detailed and lengthy information about a topic (circumstantiality), shifts in topics without any association (i.e. my mom likes dancing church on Sunday is long-referred to as loose associations), changes in a conversational topic that is logical, but never returns to the original topic (i.e.  Have you seen the giraffes with yellow spots?  Spots are on my dishes-referred to as tangentiality), strings of words that are in no way related (i.e. coffee soap car rice-referred to as word salad), use of words that have no meaning (neologisms), paranoia, a belief that things have special meaning for them alone (i.e. the newscaster is talking to them specifically-referred to as referential thinking), literal thinking (i.e. you say, “I’m going to run to the store to get ice cream” and they think you’re literally running to the store), repetition of a word or words (called verbigeration), repetition of words that sound alike but have no relation in meaning (i.e. bear, care, dare, fare, mare, etc.), called clang association, inappropriately formal language or talking very quickly.

Disorganized type Schizophrenia-the general criteria plus…

·        Any of the following behaviors:  aggression, inability to sit still or pay attention to others due to agitation,  purposeless activity or movements like grimacing or posturing, imitation of another person’s movements and gestures (echopraxia), behavior that is more child-like than previously observed, purposeless movements like pulling at clothes, crossing/uncrossing arms, etc., alertness or sustained attention as if expecting something important or frightening to happen, and/or holding a body part in an odd or unusual position for a long period of time (like a statue).

·        Use of any of the following speech patterns:  parroting another person’s words (echolalia), providing extremely detailed and lengthy information about a topic (circumstantiality), shifts in topics without any association (i.e. my mom likes dancing church on Sunday is long-referred to as loose associations), changes in a conversational topic that is logical, but never returns to the original topic (i.e.  Have you seen the giraffes with yellow spots?  Spots are on my dishes-referred to as tangentiality), strings of words that are in no way related (i.e. coffee soap car rice-referred to as word salad), use of words that have no meaning (neologisms), paranoia, a belief that things have special meaning for them alone (i.e. the newscaster is talking to them specifically-referred to as referential thinking), literal thinking (i.e. you say, “I’m going to run to the store to get ice cream” and they think you’re literally running to the store), repetition of a word or words (called verbigeration), repetition of words that sound alike but have no relation in meaning (i.e. bear, care, dare, fare, mare, etc.), called clang association, inappropriately formal language or talking very quickly.

·        A ‘flat affect,’ which essentially means the person doesn’t express emotions.  They can tell you their dog died in the same tone as they would if they won the lottery.

Catatonic Type Schizophrenia- the general criteria plus at least two of the following… 

·        Immobility without physical cause

·        Stupor

·        Excessive purposeless movement

·        Extreme negativism

·        Posturing, prominent mannerisms (i.e. a movement that the person does all the time, making them easy to recognize across a room), or prominent grimacing

·        Parroting another person’s words (echolalia)

·        Imitation of another person’s movements and gestures (echopraxia)

Undifferentiated Type Schizophrenia

·        Only the characteristics of the general criteria are met

Residual Type Schizophrenia the general criteria plus the following…

·        No prominent delusions, hallucinations, speech quirks, movement quirks or catatonic behavior

·        “Negative symptoms” which can be any of following:  ambivalence (being unable to make a decision because of opposing feelings), anhedonia (not caring about anything), limited speech, difficulty carrying on a conversation, lack of motivation.

Can it be anything else?

Psychotic symptoms can be caused by several things.  Drug use, bipolar disorder, and major depression are some of the many causes.  A thorough evaluation is required to determine the best treatment. (see Treatments & Support)